AU 2017 Hip, Knee & Shoulder Arthroplasty PDF

NATIONAL JOINT
REPLACEMENT REGISTRY
Hip, Knee & Shoulder

Arthroplasty
ANNUAL
REPORT
2017
Director: Professor Stephen Graves AOANJRR
E: segraves@aoanjrr.org.au SAHMRI,
North Terrace
Manager: Ms Cindy Turner ADELAIDE SA 5000
E: cturner@aoanjrr.org.au T: +61 8 8128 4280
The AOANJRR is funded by the Australian Government Department of Health
Photographer: John Gollings
Suggested citation:
Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, Knee & Shoulder Arthroplasty: 2017 Annual
Report. Adelaide: AOA, 2017.
www.aoa.org.au
© Australian Orthopaedic Association National Joint Replacement Registry 2017
ISSN 1445-3657
AUSTRALIAN ORTHOPAEDIC ASSOCIATION
NATIONAL JOINT REPLACEMENT REGISTRY
2017 ANNUAL REPORT
HIP, KNEE & SHOULDER ARTHROPLASTY

September 1999 to December 2016
Preface
D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6
AOANJRR | 2017 ANNUAL REPORT
Preface
It is my pleasure to present the Australian Orthopaedic Association National Joint Replacement
Registry (AOANJRR) 2017 Annual Report. Joint replacement is widely regarded to be amongst the
most successful interventions in modern surgical practice. In 2016, almost 115,000 Australians
underwent hip, knee or shoulder replacement. However, even good operations can be made
better. This was the reason that the AOA established the AOANJRR in 1999. Its sole purpose is to
enhance the outcomes of joint replacement surgery. It has been very successful at achieving this.
Through quality analysis and reporting of accurate, validated data on almost every joint
replacement procedure undertaken in Australia, the Registry has been able to provide information
that has consistently reduced the risk of revision surgery over many years. In the last year, the
benefit that AOANJRR has produced was independently assessed by the Australian Commission for
Safety and Quality. Their report identified a financial benefit of over $600M for the period 2003-2014.
Importantly, this reflects that many Australians have and continue to benefit because of the work
of the Registry. This year the AOANJRR is reporting that there continues to be ongoing
improvement. The current revision burden for hip, knee and shoulder replacement is now at its
lowest level since the Registry began data collection.
Each year the Annual Report provides information on new and important themes. This year is no
exception. For the first time, the AOANJRR has addressed the important issue of individual surgeon
and hospital variation in outcomes and examined the role that prosthesis choice has in that
variation.
An important AOANJRR function is to provide individual feedback to each surgeon. During the last
year, the Registry has worked hard to improve this information by providing more detailed data to
enable surgeons to more comprehensively assess their individual performance. In conjunction with
this, the AOA has undertaken a focused campaign and developed strategies to assist surgeons in
optimising the benefit of the information provided to them.
Another important AOA initiative developed in the last 12 months has been a two-year pilot study
to assess the feasibility of the AOANJRR undertaking national collection of Patient Reported
Outcome Measures (PROMs). If successful, it will enable the pre-operative severity of joint disease to
be more accurately assessed as well as provide the patient’s perspective on the results of their
surgery. It has the potential to deliver new insights into the indications and outcomes of joint
replacement surgery.
I would like to take this opportunity to thank all those involved with the production of the report and
the continued success of the Registry. This includes AOANJRR staff as well as the South Australian
Health and Medical Research Institute (SAHMRI) and the University of South Australia which are
AOA’s partners in managing the Registry and progressing registry science. The AOA is also grateful
for the continued support of the Commonwealth Government which provides funding for the core
activities of the Registry through a legislated cost recovery program. The Department of Health also
provides ongoing support and advice in many other ways. In addition, there are a large number of
other stakeholders supporting the Registry which include: state and territory governments; the
Therapeutic Goods Administration; industry and particularly, orthopaedic manufacturers. Finally, a
special thank you to all the hospitals, hospital coordinators, surgeons and patients for their
continued support and provision of data that has enabled the production of another extremely
high quality annual report.
Ian Incoll
President of the Australian Orthopaedic Association
D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

a o a .o rg.au 5
Executive
Summary
D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6
Executive Summary
This summary provides a brief overview of some of the major findings from this year’s Annual Report.
The basic structure of the report is similar to last year. Previously reported analysis on the outcome of
primary hip, knee and shoulder replacement has been updated and extended. For this report, the
analysis has been undertaken on 1,237,576 (545,831 hip, 653,480 knee and 38,265 shoulder) joint
replacement procedures. Each year a number of new topics are carefully selected for more
detailed analysis. This year the AOANJRR has focused on individual surgeon and hospital variation
in rate of revision and how this is affected by prosthesis choice.
As in previous years, in addition to the main report the Registry is publishing supplementary reports.
These include a Lay Summary and 11 different reports on arthroplasty topics. The Registry also
provides detailed analysis of all prostheses identified as having a higher than anticipated rate of
revision. The supplementary reports are listed in the introduction and will be available on the
AOANJRR website https://aoanjrr.sahmri.com/annual-reports-2017 from 1 October 2017.
Surgeon and Hospital Variation
Individual surgeon and hospital variation in the rate of revision were determined. Specifically, for
surgeon variation, this was done for both revision for any reason as well as specific reasons for
revision. To present variation data, funnel plots have been used for the first time. These are
explained in the relevant chapter. There are many reasons why the rate of revision varies amongst
surgeons. The Registry has on this occasion specifically focused on studying the impact of prosthesis
choice. This was done for both primary total conventional hip replacement and primary total knee
replacement. The results for both procedures were very similar. Outcomes are improved and
surgeon variation is reduced when surgeons are consistent in their use of prosthesis combinations
and when they choose to use devices that are known to have a lower rate of revision.
As with surgeon variation there are many factors that may influence hospital variation. This analysis
included assessing the extent of individual hospital variation for primary total conventional hip
replacement used in the management of osteoarthritis and fractured neck of femur, as well as
primary total knee replacement for osteoarthritis. A comparison of the rate of revision in public and
private hospital systems was also undertaken, and the impact of prosthesis choice on that
comparison was studied. The initial higher rate of revision observed in private hospitals for primary
total conventional hip (both diagnoses) and primary total knee replacement altered when the
comparison was confined to prosthesis combinations that are known to have a lower rate of
revision. For primary total conventional primary hip replacement with a primary diagnosis of
osteoarthritis, the rate of revision in private hospitals was less in the first month and the same as for
public hospitals after that time. When this procedure was performed for a primary diagnosis of
fractured neck of femur, there was no difference in the rate of revision. For primary total knee
replacement, the rate of revision was lower in private hospitals when procedures using only those
prosthesis combinations with a lower rate of revision were considered.
10 and 15 Year Outcome Data
The Registry continues to highlight the 10 year and 15 year cumulative percent revision of prosthesis
combinations used in primary total conventional hip and primary total knee replacement. These
are important milestones to benchmark comparative prosthesis performance. Applying a more
stringent benchmarking approach at 10 years (explained in the relevant chapter), 19.2% of hip
prosthesis combinations and 16.1% of knee prosthesis combinations achieve a 10 year superiority
benchmark.
Hip Replacement Data
In 2016, hip replacement increased by 3.7% and revision burden declined to 8.9%, which is the
lowest level reported by the Registry. In primary partial hip replacement, the use of bipolar
prostheses continues to increase and has a lower rate of revision compared to other types of
partial hip replacement in the management of fractured neck of femur. Cement fixation of the
femoral component is associated with the lowest rate of revision.
There have been a number of changes in the analysis of primary total conventional hip
replacement. Non cross-linked polyethylene (non XLPE) has been excluded from the fixation
analysis. Consequently, the outcome of cement fixation has improved compared to that previously

a o a .o rg.au 7
reported by the Registry. The rate of revision of cross-linked polyethylene (XLPE) + antioxidant is
included for the first time. The follow up period is short (maximum 4 years), but at this point in time
there is no difference when compared to XLPE. To reflect current surgical practice the analysis of
ceramic on ceramic bearings has been limited to mixed ceramic. A separate section on the
outcome of primary total conventional hip replacement for fractured neck of femur has been
included for the first time. In addition, primary total conventional hip replacement is compared to
primary partial hip replacement, with an analysis and explanation of competing risks also included.
This approach better addresses the high but variable mortality associated with the different
prosthesis classes used in fractured neck of femur, and enables a more relevant comparison of the
comparative revision incidence.
The data on total resurfacing hip replacement is similar to previous years.
Knee Replacement Data
In 2016, knee replacement increased by 3.5% and revision burden declined to 7.4%. As with hip
replacement, this is the lowest knee revision burden reported by the Registry. The major change in
the knee replacement analysis has been the inclusion of medial pivot knee replacement as a
separate class of primary total knee replacement. The rate of revision of XLPE + antioxidant is also
included for the first time.
Shoulder Replacement Data
In 2016, shoulder replacement increased by 11.1% and revision burden declined to its lowest level
of 9.1%. The use of total reverse shoulder replacement continues to increase and in 2016
accounted for 69.3% of all total shoulder replacements. After 3 months, total reverse shoulder
replacement has a lower rate of revision compared to total conventional shoulder replacement
when the SMR L2 is excluded. In primary total conventional shoulder replacement, the use of
cemented glenoid fixation continues to increase and its lower rate of revision is again highlighted.
Larger head sizes are associated with a lower rate of revision. There is no difference related to
fixation in total reverse shoulder replacement, but there are differences related to glenosphere size
when used in the management of osteoarthritis.
Prostheses with Higher than Anticipated Rates of Revision
Each year, the AOANJRR identifies prostheses with higher than anticipated rates of revision. This
year, six new prostheses have been identified: one acetabular prosthesis, four hip prosthesis
combinations and one primary total knee prosthesis.
8 ao a. o rg. au D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6

Acknowledgements
The Registry continues to receive support and invaluable assistance from the Commonwealth
Government, state and territory health departments and orthopaedic companies.
The Registry acknowledges the cooperation and support provided by those undertaking the
surgery and completing the data forms, in particular, all orthopaedic surgeons, registrars and
nursing staff.
The Registry would also like to acknowledge the ongoing support of all hospitals, both public and
private, that undertake arthroplasty surgery nationally. The support provided by each hospital
through their nominated coordinator(s) is appreciated. A complete list of participating hospitals
and coordinators is presented at the end of this report (Appendix 1).
The Registry greatly appreciates the participation of all joint replacement patients throughout
Australia. It is their contribution that allows ongoing improvements in arthroplasty outcomes to be
achieved.
DEPUTY DIRECTORS DIRECTOR AOANJRR STAFF

Professor Richard de Steiger Professor Stephen Graves Ms Cindy Turner (Manager)
Mr Peter Lewis Dr Sophia Rainbird
Professor Ian Harris Ms Rychelle Brittain
Ms Grace O’Donohue
Assistant Deputy Directors Clinical Advisors
Mr James Stoney Professor Richard Page (Upper Limb Joint Replacement)
Mr Bill Donnelly Mr Andrew Beischer (Ankle Replacement)
SOUTH AUSTRALIAN HEALTH AND MEDICAL RESEARCH INSTITUTE STAFF

Ms Liddy Griffith
Dr Mandy Anderson
Ms Michelle Lorimer
Ms Alana Cuthbert
Ms Andrea Peng
Ms Alesha Hatton
Ms Janey Barrow
Mr Robert Armitage
Many thanks to the Data Entry Team
AOANJRR COMMITTEE
David Hale Chairperson
Stephen Graves Director
Richard de Steiger Deputy Director (Victoria)
Peter Lewis Deputy Director (South Australia)
Ian Harris Deputy Director (New South Wales)
Roger Brighton New South Wales
John Radovanovic Queensland
Alexander Burns Australian Capital Territory
Sean Williams Western Australia
Russell Furzer Tasmania
David Campbell President, Arthroplasty Society of Australia
Neil Bergman AOA Representative - AOANJRR Consultative Committee
Peter Myers Australian Knee Society
Richard Page Shoulder & Elbow Society Representative
Andrew Beischer Foot & Ankle Society Representative
Matthew Scott-Young Spine Society of Australia Representative
James Stoney Assistant Deputy Director (observer status)
Bill Donnelly Assistant Deputy Director (observer status)
| 99
Page
a o a .o rg.au
Data Period 1 September 1999 – 31 December 2016

Contents
INTRODUCTION...................................................................................................................................................12
Background......................................................................................................................................................12
Purpose.............................................................................................................................................................13
Aims...................................................................................................................................................................13
Benefits..............................................................................................................................................................13
Governance.....................................................................................................................................................13
DATA QUALITY....................................................................................................................................................15
Data Collection................................................................................................................................................15
Data Validation................................................................................................................................................15
Outcome Assessment......................................................................................................................................15
Report Review Prior to Publication.................................................................................................................16
SURGEON AND HOSPITAL VARIATION..............................................................................................................19
Surgeon Variation............................................................................................................................................19
Hospital Variation.............................................................................................................................................36
TEN AND FIFTEEN YEAR PROSTHESIS OUTCOMES..............................................................................................45
Ten Year Outcomes.........................................................................................................................................45
Hip Replacement.............................................................................................................................................45
Knee Replacement.........................................................................................................................................48
Fifteen Year Outcomes...................................................................................................................................50
Hip Replacement.............................................................................................................................................50
Knee Replacement.........................................................................................................................................50
HIP REPLACEMENT..............................................................................................................................................53
Categories of Hip Replacement....................................................................................................................53
Use of Hip Replacement.................................................................................................................................54
ASA Score and BMI in Hip Replacement......................................................................................................55
PRIMARY PARTIAL HIP REPLACEMENT...............................................................................................................57
Classes of Partial Hip Replacement...............................................................................................................57
Use of Partial Hip Replacement.....................................................................................................................57
Unipolar Monoblock........................................................................................................................................60
Unipolar Modular.............................................................................................................................................66
Bipolar................................................................................................................................................................73
PRIMARY TOTAL HIP REPLACEMENT...................................................................................................................80
Classes of Total Hip Replacement.................................................................................................................80
Use of Total Hip Replacement........................................................................................................................80
Primary Total Conventional Hip Replacement.............................................................................................81
Primary Total Resurfacing Hip Replacement..............................................................................................152
KNEE REPLACEMENT.........................................................................................................................................165
Categories of Knee Replacement...............................................................................................................165
Use of Knee Replacement............................................................................................................................166
ASA Score and BMI in Knee Replacement.................................................................................................167
PRIMARY PARTIAL KNEE REPLACEMENT..........................................................................................................169
Classes of Partial Knee Replacement.........................................................................................................169
Use of Partial Knee Replacement................................................................................................................169
Partial Resurfacing.........................................................................................................................................170
Patella/Trochlea.............................................................................................................................................172
Unicompartmental........................................................................................................................................178
PRIMARY TOTAL KNEE REPLACEMENT.............................................................................................................186
Class of Total Knee Replacement................................................................................................................186
SHOULDER REPLACEMENT................................................................................................................................229
Categories of Shoulder Replacement........................................................................................................229
Use of Shoulder Replacement......................................................................................................................230
ASA Score and BMI........................................................................................................................................231
PRIMARY PARTIAL SHOULDER REPLACEMENT.................................................................................................233
Classes of Partial Shoulder Replacement...................................................................................................233
Use of Partial Shoulder Replacement..........................................................................................................233
Primary Partial Resurfacing Shoulder Replacement..................................................................................237
Primary Hemi Resurfacing Shoulder Replacement....................................................................................238
Primary Hemi Mid Head Shoulder Replacement.......................................................................................243
Primary Hemi Stemmed Shoulder Replacement.......................................................................................244
PRIMARY TOTAL SHOULDER REPLACEMENT....................................................................................................259
Classes of Total Shoulder Replacement......................................................................................................259
Use of Total Shoulder Replacement............................................................................................................259
Primary Total Resurfacing Shoulder Replacement.....................................................................................264
Primary Total Mid Head Shoulder Replacement........................................................................................266
Primary Total Conventional Shoulder Replacement.................................................................................268
Primary Total Reverse Shoulder Replacement...........................................................................................288
PROSTHESES WITH HIGHER THAN ANTICIPATED RATES OF REVISION............................................................319
Introduction....................................................................................................................................................319
Identified Prostheses......................................................................................................................................320
Primary Partial Hip Replacement.................................................................................................................321
Primary Total Hip Replacement....................................................................................................................325
Total Resurfacing............................................................................................................................................337
Primary Partial Knee Replacement..............................................................................................................339
Primary Total Knee Replacement................................................................................................................342
Primary Partial Shoulder Replacement........................................................................................................349
Primary Total Shoulder Replacement..........................................................................................................350
Primary Total Reverse Shoulder Replacement...........................................................................................352
Primary Total Ankle Replacement...............................................................................................................353
APPENDICES.....................................................................................................................................................354
APPENDIX 1.....................................................................................................................................................355
APPENDIX 2.....................................................................................................................................................359
APPENDIX 3.....................................................................................................................................................362
APPENDIX 4.....................................................................................................................................................365
APPENDIX 5.....................................................................................................................................................367
APPENDIX 6.....................................................................................................................................................368
APPENDIX 7.....................................................................................................................................................369
LIST OF TABLES..................................................................................................................................................370
LIST OF FIGURES................................................................................................................................................375
Introduction
The 2017 Hip, Knee and Shoulder Arthroplasty techniques used to implant them were
Report is based on the analysis of 1,237,576 unknown.
(545,831 hip, 653,480 knee and 38,265 shoulder)
primary and revision procedures recorded by The need to establish a Registry was, in part,
the Registry, with a procedure date up to and based on the documented success of a
including 31 December 2016. Shoulder number of arthroplasty registries in other
arthroplasty has been included in this report countries. In particular, the Swedish arthroplasty
with hip and knee arthroplasty since 2016. registries. In Sweden, the ability to identify
factors important in achieving successful
In addition, there are 12 supplementary reports outcomes has resulted in both improved
that complete the AOANJRR Annual Report for standards and significant cost savings.
2017:
In 1998, the Commonwealth Department of
1. Lay Summary – Hip & Knee Replacement Health (DoH) funded the AOA to establish the
2. Demographics of Hip, Knee & Shoulder Registry. The Department of Health continues to
Arthroplasty provide funding to maintain the Registry. In
3. Cement in Hip and Knee Arthroplasty June 2009, Federal Parliament passed
4. Mortality of Hip and Knee Arthroplasty legislation to enable the government to cost
5. Revision of Hip and Knee Arthroplasty recover this funding from the orthopaedic
6. Metal/Metal Bearing Surface in Total industry. This legislation was updated in 2015.
Conventional Hip Arthroplasty
7. Metal and Ceramic Bearing Surface in Total The Registry began hip and knee data
Conventional Hip Arthroplasty collection on 1 September 1999.
8. The Outcome of Classes of Hip and Knee Implementation was undertaken in a staged
Prostheses No Longer Used manner in each of the Australian states and
9. Demographics and Outcome of Elbow and territories, becoming national during 2002. The
Wrist Arthroplasty first year of full national data collection for
10. Demographics and Outcome of Ankle shoulder procedures was 2008 (Appendix 6).
Arthroplasty
11. Demographics of Spinal Disc Arthroplasty The AOA contracts the South Australian Health
12. Analysis of State and Territory Health Data – and Medical Research Institute (SAHMRI) to
All Arthroplasty 1993/1994 – 2015/2016 provide data management and independent
data analysis services for the Registry.
In addition to the 12 supplementary reports,
investigations of prostheses with higher than The SAHMRI team contribute crucial data
anticipated rates of revision are published on management and analysis expertise through
https://aoanjrr.sahmri.com/annual-reports-2017. the Registry Working Group and a variety of
project working groups.
All hospitals, public and private, undertaking
joint replacement submit their data to the The AOA also contracts the University of South
Registry. Currently, there are 310 participating Australia to provide specific expertise in the
hospitals. However, this may vary from time to ongoing development of analytical techniques
time due to hospital closures, new hospitals, or for registry data.
changes to services within hospitals.
BACKGROUND
Joint replacement is a commonly performed
major surgical procedure that has considerable
success in alleviating pain and disability.
The Australian Orthopaedic Association (AOA)
recognised the need to establish a national
joint replacement registry in 1993. At that time,
the outcome of joint replacement in Australia
was unknown. Patient demographics were not
available and the types of prostheses and
12 ao a. o rg. a u D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6

PURPOSE
The purpose of the Registry is to define, improve coexisting influence is the rapid rate of change
and maintain the quality of care for individuals in medical technology. There is continual
receiving joint replacement surgery. This is development and use of new types of
achieved by collecting a defined minimum prostheses and surgical techniques, for many of
data set that enables outcomes to be which the outcome remains uncertain.
determined based on patient characteristics,
prosthesis type and features, method of Information obtained by the analysis of Registry
prosthesis fixation and surgical technique used. data is used to benefit the community. The
Registry releases this information through
The principal outcome measure is time to first publicly available annual and supplementary
revision surgery. This is an unambiguous reports, journal publications and ad hoc reports
measure of the need for further intervention. (256 in 2016). These ad hoc reports are specific
Combined with a careful analysis of potential analyses requested by surgeons, hospitals,
confounding factors, this can be used as an academic institutions, government and
accurate measure of the success, or otherwise, government agencies as well as orthopaedic
of a procedure. The Registry also monitors companies.
mortality of patients, which is critical when
determining the rate of revision. The Registry provides surgeons with access to
their individual data and downloadable reports
AIMS through a secure online portal. Separate online
facilities are available for orthopaedic
1. Establish demographic data related to joint
companies to monitor their own prostheses,
replacement surgery in Australia.
and for Australian and regulatory bodies in
2. Provide accurate information on the use of
other countries to monitor prostheses used in
different types of prostheses.
Australia. The data obtained through the online
3. Determine regional variation in the
facilities are updated daily and are over 90%
practice of joint surgery.
complete within six weeks of the procedure
4. Identify the demographic and diagnostic
date.
characteristics of patients that affect
outcomes.
The percentage of revision hip procedures has
5. Analyse the effectiveness of different
declined from a peak of 12.9% in 2003 to 8.9% in
prostheses and treatment for specific
2016, equating to 1,871 fewer hip revisions in
diagnoses.
2016. The percentage of revision knee
6. Evaluate the effectiveness of the large
procedures has declined from a peak of 8.8% in
variety of prostheses currently on the
2004 to 7.4% in 2016, equating to 834 fewer
market by analysing their survival rates.
knee revisions in 2016. Revision shoulder
7. Educate orthopaedic surgeons on the most
arthroplasty peaked at 10.8% in 2012 and 2015,
effective prostheses and techniques to
and has declined to 9.1% in 2016.
improve patient outcomes.
8. Provide surgeons with an auditing facility.
A major reason for the reduction in revision
9. Provide information that can instigate
following hip, knee and shoulder joint
tracking of patients if necessary.
replacement is the increased use of the type
10. Provide information for the comparison of
and class of prostheses shown to have better
the practice of joint replacement in
outcomes, and an associated decline in use of
Australia and other countries.
prostheses when less satisfactory outcomes are
identified.
BENEFITS
Since its inception, the Registry has enhanced GOVERNANCE
the outcome of joint replacement surgery in
The AOANJRR is an initiative of the AOA funded
Australia.
by the Commonwealth Government. In 2009,
the Commonwealth established the AOANJRR
There are many factors known to influence the
Consultative Committee, which is administered
outcome of joint replacement surgery. Some of
and chaired by the Department of Health. The
these include age, gender, diagnosis, ASA
purpose is to provide advice on the overall
score and BMI of patients, as well as the type of
strategic direction of the Registry.
prosthesis and surgical technique used. Another

a o a .o rg.au 13
Consultative Committee Members arthroplasty groups are included. A complete

1. Chair, Department of Health list of the current AOANJRR Committee is
2. AOANJRR Director provided in the acknowledgements section of
3. A representative of: this report.
a. Department of Health
b. Australian Orthopaedic Association The Director, Deputy Directors and Assistant
c. Consumers Health Forum Deputy Directors are appointed by the AOA
d. Therapeutic Goods Administration Board and are responsible for providing
e. Prostheses List Advisory Committee strategic and clinical guidance. Additionally,
f. Private Healthcare Australia the Directors are responsible for ensuring the
g. Australian Private Hospitals Association cooperation of hospitals, surgeons and
h. Orthopaedic Industry (2): government, maintaining the profile and
i. Medical Technology Association reputation of the Registry, continued
of Australia collaboration with other arthroplasty registries
ii. Non Medical Technology internationally, and sustaining the current level
Association of Australia of excellence.
The National Board of the AOA established the The AOANJRR staff include the Registry
AOANJRR Committee to develop and manage Manager, Administration Officer, Research
AOANJRR policies. The Committee reports to Coordinator and Prosthesis Library Coordinator.
the AOA Board. Members include the The AOANJRR team are responsible for the day-
Chairperson, AOANJRR Director, three to-day operations, implementing new
AOANJRR Deputy Directors and two Assistant strategies, provision of data reports, research
Deputy Directors. In addition, an orthopaedic and publications activity, and coordinating the
surgeon from each state, the ACT, and a preparation of the Annual Report.
representative from each of the AOA specialty

Data Quality
DATA COLLECTION Data errors can occur within Government or
Registry data at any of these levels; that is,
Hospitals provide data on specific Registry errors in patient identification, coding or
forms, which are completed in theatre at the admission period attribution by either the
time of surgery and submitted to the Registry hospital, state/territory health department or
each month. Examples of Registry data forms the Registry. Data mismatches are managed
are available on the website. depending on the nature of the error. For
example, a health department record for a
Hard copy forms are sent to the Registry where primary ‘knee’ may match a Registry held
a small team of expert data entry staff enter record for a ‘hip’ on all parameters except
the data directly into the database. Onsite procedure type. The Registry would regard the
Data Managers are available to resolve queries Registry data to be correct in this instance as
at the time of data entry to reduce any the Registry record contains details of the
potential data entry errors. The Registry data prostheses implanted. Other errors may be
entry system uses a predictive text function resolved by contacting hospitals for
which greatly reduces the possibility of clarification. Most commonly, this may include
transcription errors and enables the a reassessment of procedure codes or
experienced data entry staff to enter the data admission period.
rapidly and accurately.
In the 2016/17 financial year, the Registry
The Registry has also established mechanisms to received 202 more hip, knee and shoulder
collect data electronically when it becomes procedures than were provided in the various
feasible for contributing hospitals to do so. To health department data files.
date, there are no hospitals providing data
electronically. The validation process identifies procedures not
submitted to the Registry. As in previous years,
DATA VALIDATION the majority of these procedures have an
The Registry validates data collected from both ICD10 code for hemiarthroplasty of the femur.
public and private hospitals by comparing it to Sufficient information is provided in the state
data provided by state and territory health unit record data to enable the Registry to
departments. Validation of Registry data is a request hospitals to provide forms for
sequential multi-level matching process against unreported procedures.
health department unit record data.
The Registry is able to obtain over 98% of joint
The validation process identifies: replacement procedures undertaken in
1. Registry procedure records for Australia. On initial submission of forms from
procedures notified to state/territory participating hospitals, the Registry’s capture
health departments by hospitals. rate is 96.8%. Following verification against
2. State/territory records for procedures health department data, checking of
not submitted to the Registry by unmatched data and subsequent retrieval of
hospitals. unreported procedures, the Registry is able to
3. ‘Exact match’ procedures, that is, obtain an almost complete dataset relating to
records held by the Registry and hip, knee and shoulder replacement in
state/territory health departments. Australia.
4. Procedures that match on some
parameters, but which require OUTCOME ASSESSMENT
additional checking with hospitals to The Registry describes the time to first revision
enable verification. using the Kaplan-Meier estimates of survivorship.
The cumulative percent revision at a certain
Initial validation is performed using hospital and time, for example five years, is the complement
patient identity numbers with subsequent (in probability) of the Kaplan-Meier survivorship
verification undertaken on relevant procedure function at that time, multiplied by 100. The
codes and appropriate admission periods. cumulative percent revision accounts for right
censoring due to death and ‘closure’ of the
database at the time of analysis.

a o a .o rg.au 15
Mortality information is obtained by matching such a competing risk. In circumstances where

all procedures with the National Death Index the risk of death is high, e.g. in elderly patients
(NDI) biannually. The NDI is the national with fractured neck of femur, the bias in the
mortality database maintained by the Kaplan-Meier estimates may be substantial and
Australian Institute of Health and Welfare the reported cumulative percent revision
(AIHW). The AIHW requires ethics approval for should be interpreted with caution.
access to the NDI data.
The Registry is currently investigating the
Prior to 2013, the Registry reported the revisions introduction of different analytical methods to
per 100 observed component years. This cope with competing risks. Cumulative
statistic provides a good estimate of the overall incidence is one method of estimating the
rate of revision. However, it does not allow for probability of revision in the presence of
changes in the rate of revision over time. A competing risks. Cumulative incidence revision
more informative estimate of the rate of revision diagnosis graphs deal with the competing risks
over time is the cumulative percent revision. of reasons for revision, highlighting the
differences between groups in the pattern of
Confidence intervals for the cumulative revision over time. They also provide important
percent revision are unadjusted point-wise insight into different mechanisms of failure. This
Greenwood estimates and should not be used year the Registry has provided cumulative
to infer significant differences in revision incidence of revision for primary total
between groups. Reported hazard ratios should conventional hip replacement compared to
be used when judging statistical significance. other types of primary hip arthroplasty used for
the management of fractured neck of femur.
Hazard ratios (HR) from Cox proportional
hazards models, adjusting for age and gender More detailed information on the statistical
where appropriate, are used to compare rates methods used in this report is presented in
of revision. For each model, the assumption of Appendix 2.
proportional hazards is checked analytically. If
the interaction between the predictor and the An important Registry focus has been the
log of time is statistically significant in the continued development of a standardised
standard Cox model, then a time varying algorithm to identify prostheses or combination
model is estimated. Time points are iteratively of prostheses not performing to the level of
chosen until the assumption of proportionality is others in the same class. The Registry refers to
met, then the hazard ratios are calculated for this group as ‘prostheses with a higher than
each selected time period. If no time period is anticipated rate of revision’. A three-stage
specified, then the hazard ratio is over the approach has been developed and is outlined
entire follow up period. All tests are two-tailed in detail in the relevant chapter of the report.
at the 5% level of significance.
REPORT REVIEW PRIOR TO PUBLICATION
The cumulative percent revision (CPR) is
Prior to publication there are two workshops
displayed until the number at risk for the group
held to review, comment, and provide advice
reaches 40, unless the initial number for the
on the report. Members of the AOA and
group is less than 100, in which case the
Arthroplasty Society are invited to attend a
cumulative percent revision is reported until 10%
two-day workshop to review all sections of the
of the initial number at risk remains. This avoids
report other than the shoulder procedures
uninformative, imprecise estimates at the right
section. This workshop was held in Adelaide on
tail of the distribution where the number at risk is
the weekend of 5 and 6 August 2017. Members
low. Analytical comparisons of revision rates
of the AOA with expertise in shoulder surgery
using the proportional hazards model are
are invited to attend a separate workshop to
based on all available data1.
review this section of the report. This second
workshop was held in Adelaide on 12 August
In the presence of a competing risk for revision,
2017. Following these workshops, the report was
the Kaplan-Meier method is known to
provided to the AOA Board for consideration
overestimate the true probability of revision.
and final approval prior to publication.
Death of the patient before revision presents
1
Pocock SJ, Clayton TC, Altman DG. Survival plots of time to event outcomes in
clinical trials: good practice and pitfalls, Lancet 2002; 359: 1686-89.


a o a .o rg.au 17
2017
Surgeon and Hospital Variation
This year, the Registry reports on the variation in SURGEON VARIATION

rate of revision between surgeons and
Variation between surgeons should be
hospitals. The purpose is to provide insight into
interpreted within the limitations of the data.
the role of surgeon and hospital related factors
Firstly, some degree of random variation
in the outcome of joint replacement surgery.
between surgeons is expected. For surgeons
who undertake fewer procedures, more
The Registry has previously reported on
random variation is expected; this gives rise to
surgeon factors such as surgeon volume
the ‘funnel’ shape of the graph, with wider
(number of procedures performed each year)
confidence limits to the left of the graph.
and surgeon experience (time since
qualification). This chapter further explores
Secondly, the variation seen between
surgeon variation in the rate of revision for both
surgeons may be due to factors unrelated to
primary total conventional hip and primary
surgeon performance or surgeon preference.
total knee replacement, the reasons for
All funnel plots in this chapter are adjusted for
revision and the impact of prosthesis choice on
differences in patient age and gender, but not
the degree of surgeon variation. In addition, it
for other factors that may also influence the
also examines the impact of prosthesis choice
outcome. For example, a higher proportion
on hospital variation.
may be expected for surgeons performing
more difficult procedures.
Funnel plots (in addition to previously used
graphs) are used to display variation in revision.
Due to the increased variation seen with low
A funnel plot is a scatter plot where each point
numbers, we have restricted the graphs to only
represents a single surgeon or single hospital.
include surgeons with at least 50 procedures
The X (horizontal) axis represents volume: the
recorded by the Registry.
total number of relevant surgical procedures
recorded by the Registry for each surgeon or This analysis is restricted to primary total
hospital. The Y-axis is a measure of conventional hip replacement and primary
performance given by the standardised total knee replacement performed for
proportion. This is calculated for each surgeon osteoarthritis since 1 January 2003. The Registry
or hospital as the ratio of the number of contains data on 1,427 surgeons who have
revisions observed to the number of revisions performed primary hip or knee replacement
expected, multiplied by the overall proportion surgery, 1,010 (70.8%) of which contributed
of revisions. To calculate the expected number new procedures in 2016. The number of
of revisions, a logistic regression model is used surgeons that have performed 50 or more total
to determine the probability of revision based conventional hip replacements is 651 and 50 or
on a patient’s age and gender. The sum of more total knee replacements is 800.
these predicted values for each surgeon or
hospital is the estimate of the expected
number of revisions.
The degree of variation expected is displayed

on the graph as yellow (95% upper confidence
limit) and red (99.7% upper confidence limit)
lines which indicate the upper confidence
limits around the average (or overall) revision
rate for all procedures (indicated by the green
line).

a o a .o rg.au 19
TOTAL CONVENTIONAL HIP REPLACEMENT

Individual surgeon variation in revision for any (above the upper 99.7% confidence limit) is
reason following primary total conventional hip 7.4% (Figure SV1). This analysis was repeated
replacement, irrespective of prostheses used, excluding large head metal/metal prostheses,
was assessed. Overall, the proportion of for which the overall proportion of procedures
primary procedures revised is 4.0%. The revised is 3.3% and the percentage of surgeon
percentage of surgeons who are outliers outliers is 6.8% (Figure SV2).
Figure SV1 Funnel Plot of Primary Total Conventional Hip Replacement by Surgeon (Primary Diagnosis OA, Revision for Any
Reason)
0.25
Overall Proportion
95% Confidence Limit
99.7% Confidence Limit
0.20
Standardised Proportion
0.15
0.10
0.05
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650 2850
Total Number of Procedures
Figure SV2 Funnel Plot of Primary Total Conventional Hip Replacement by Surgeon (Primary Diagnosis OA, Excluding Large
Head (>32mm) Metal/Metal, Revision for Any Reason)
0.25
Overall Proportion
0.20
0.15
0.10
0.05
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650
Note: All procedures using metal/metal prostheses with head size larger than 32mm have been excluded

The analysis excluding large head metal/metal procedures revised is 2.6% and the percentage
prostheses was repeated but restricted to of surgeon outliers is 7.9% (Figure SV3).
procedures performed from 2008 to 2016. This
period was selected for several reasons, the Further restricting the analysis to a shorter
most important being that 2008 was the first follow up time (two years) minimises the
year the Registry could reliably link almost all impact of revision for reasons such as implant
procedures to specific surgeons. In addition, wear, and focuses the analysis more on
the outcomes during this period more surgeon factors. The proportion of procedures
accurately reflect current surgical practice. For revised for any reason within two years is 1.9%
this period, the overall proportion of and the percentage of surgeon outliers is 7.4%
(Figure SV4).
Figure SV3 Funnel Plot of Primary Total Conventional Hip Replacement by Surgeon performed from 1 January 2008 (Primary
Diagnosis OA, Revision for Any Reason)
0.16
Overall Proportion
0.14 99.7% Confidence Limit
0.12
0.10
0.08
0.06
0.04
0.02
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650
Reason Within 2 Years)
0.12
Overall Proportion
0.10
0.08
0.06
0.04
0.02
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650

a o a .o rg.au 21
An analysis was undertaken to determine the The proportion of procedures revised within
percentage of surgeon outliers for specific two years for dislocation, infection, fracture
reasons for revision. The four most common and loosening are 0.51%, 0.45%, 0.38% and
reasons for revision of primary total 0.37%, respectively. The percentage of surgeon
conventional hip replacement are: dislocation, outliers for each of these revision diagnoses is
infection, fracture and loosening. Knowing the 5.9%, 6.2%, 3.9%, and 5.4% respectively (Figures
reason and timing of the revision has the SV5 to SV8).
potential to enable surgeons to identify
modifiable factors, which may enable them to Of the 122 surgeon outliers in these four plots,
enhance the outcomes of their surgery. 87.7% appear in one, 11.5% appear in two and
0.8% appear in three plots.
Figure SV5 Funnel Plot of Primary Total Conventional Hip Replacement by Surgeon (Primary Diagnosis OA, Revision for
Prosthesis Dislocation Within 2 Years)
0.08
Overall Proportion
0.06
0.04
0.02
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650
Infection Within 2 Years)
0.08
Overall Proportion
0.06
0.04
0.02
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650

Figure SV7 Funnel Plot of Primary Total Conventional Hip Replacement by Surgeon (Primary Diagnosis OA, Revision for Fracture
Within 2 Years)
0.04
Overall Proportion
0.03
0.02
0.01
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650
Loosening Within 2 Years)
0.06
Overall Proportion
0.04
0.02
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650

a o a .o rg.au 23
PROTHESIS CHOICE
The effect of prosthesis choice on surgeon
variation was explored. Two approaches were
used. The first involved assessing the rate of Surgeons who are more consistent in
revision based on the consistency of prosthesis prosthesis choice have a lower rate of
combinations used by a surgeon. The second revision.
compared the extent of surgeon variation
when only better performing prosthesis
Use of Better Performing Prostheses
combinations were used.
An analysis was undertaken to determine if the
association between consistency and a lower
Consistency of Prosthesis Use
rate of revision may be due to preferential
This analysis is based on the proportion of selection of better performing prosthesis
procedures where a surgeon used up to two combinations by surgeons using fewer devices.
prosthesis combinations. As an example, a The 10 prosthesis combinations with the lowest
figure of 75% for a given surgeon means that cumulative percent revision at five years and
they used two prostheses for 75% of all their at least 1,000 procedures were chosen for this
procedures. In the remaining 25%, different analysis. The number of prosthesis
prosthesis combinations were used. The combinations (10) was chosen to focus on the
Registry regards this as a measure of surgeon effect of prosthesis choice and still provide
consistency in prosthesis choice. enough data (procedure numbers) to preserve
statistical power. There are many prosthesis
Surgeons were then grouped according to combinations with a similar low rate of revision
consistency. Three surgeon groups were that were not included in this analysis.
selected: when a surgeon used a maximum of
two prosthesis combinations in more than 90%, Surgeons with greater consistency in prosthesis
70 to 90% and less than 70% of their choice are more likely to use these 10
procedures. prosthesis combinations (30.8% compared to
25.3% and 17.4% for the other two surgeon
Two prosthesis combinations were chosen, as groups) (Table SV3).
surgeons will often use two different prosthesis
combinations depending on the clinical The cumulative percent revision for each
indications. Due to limitations in surgeon surgeon group, restricted to procedures using
specific data prior to 2008, and to provide these 10 prosthesis combinations, is provided in
more recent data, this analysis was restricted Table SV4 and Figure SV10. After six months,
to procedures from 2008. The number of there is no difference in outcome between
surgeons in each group is shown in Table SV1. surgeon groups when these 10 prosthesis
combinations are used.
Table SV1 Number of Surgeons within each Prosthesis
Consistency Group The role of prosthesis selection was also
Prosthesis Consistency Group N Surgeons evaluated by determining the percentage of
>90% 224 surgeon outliers when the 10 prosthesis
combinations with the lowest five year
70-90% 213
cumulative percent revision were used,
<70% 185
compared to when all other prosthesis
combinations were used. The proportion of
The cumulative percent revision decreases surgeon outliers when the 10 prosthesis
with increased surgeon consistency (less combinations with the lowest five year
variability) in prosthesis choice (Table SV2 and cumulative percent revision were used is 1.7%
Figure SV9). This indicates that surgeons who and when all other prosthesis combinations
are more consistent in prosthesis choice have were used the proportion of surgeon outliers is
a lower rate of revision. 7.8% (Figures SV11 and SV12).

Table SV2 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Prosthesis Consistency (Primary
Diagnosis OA)
N N
Prosthesis Consistency 1 Yr 3 Yrs 5 Yrs 6 Yrs 7 Yrs 8 Yrs
Revised Total
>90% 1424 60949 1.4 (1.3, 1.5) 2.1 (2.0, 2.3) 2.8 (2.6, 2.9) 3.1 (2.9, 3.3) 3.4 (3.2, 3.6) 3.8 (3.5, 4.0)
70-90% 1609 64522 1.5 (1.4, 1.6) 2.4 (2.2, 2.5) 3.0 (2.9, 3.2) 3.4 (3.2, 3.6) 3.7 (3.5, 3.9) 4.0 (3.7, 4.2)
<70% 1704 64170 1.7 (1.6, 1.8) 2.5 (2.4, 2.6) 3.1 (2.9, 3.3) 3.4 (3.3, 3.6) 3.8 (3.6, 4.0) 4.2 (3.9, 4.5)
TOTAL 4737 189641
Figure SV9 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Prosthesis Consistency (Prosthesis
Combinations) (Primary Diagnosis OA)
HR - adjusted for age and gender
6%
>90% 70-90% vs >90%
70-90%
Entire Period: HR=1.09 (1.02, 1.17),p=0.016
<70%
5%
<70% vs >90%
0 - 1Mth: HR=1.18 (1.05, 1.34),p=0.006
Cumulative Percent Revision
1Mth - 3Mth: HR=1.24 (1.06, 1.44),p=0.006

4%
3Mth - 6Mth: HR=1.31 (1.07, 1.61),p=0.009
6Mth+: HR=1.07 (0.98, 1.18),p=0.127
3%
<70% vs 70-90%
2%
1%
0%
0 1 2 3 4 5 6 7 8
Years Since Primary Procedure
Number at Risk 0 Yr 1 Yr 3 Yrs 5 Yrs 6 Yrs 7 Yrs 8 Yrs

>90% 60949 50942 33203 19336 12915 7534 3015
70-90% 64522 53034 33691 18692 12526 7416 3039
<70% 64170 53253 34693 19599 13221 7732 2956

a o a .o rg.au 25
Table SV3 Primary Total Conventional Hip Replacement by Prosthesis Consistency and Prosthesis Combination Used (Primary
Diagnosis OA)
10 Prosthesis Combinations with Lowest Other Prosthesis

TOTAL
5 Year CPR Combinations
Prosthesis Consistency N Row% N Row% N Row%
>90% 18752 30.8 42197 69.2 60949 100.0
70-90% 16331 25.3 48191 74.7 64522 100.0
<70% 11175 17.4 52995 82.6 64170 100.0
TOTAL 46258 24.4 143383 75.6 189641 100.0
Table SV4 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Prosthesis Consistency, using the
10 Prosthesis Combinations with Lowest 5 Year CPR (Primary Diagnosis OA)
N N
Revised Total
>90% 302 18752 1.0 (0.8, 1.1) 1.5 (1.3, 1.7) 1.9 (1.7, 2.2) 2.2 (1.9, 2.4) 2.3 (2.0, 2.6) 2.5 (2.2, 2.9)
70-90% 292 16331 1.1 (1.0, 1.3) 1.7 (1.5, 1.9) 2.1 (1.8, 2.3) 2.3 (2.0, 2.6) 2.6 (2.2, 3.0) 2.6 (2.3, 3.1)
<70% 200 11175 1.3 (1.1, 1.5) 1.7 (1.5, 2.0) 2.0 (1.8, 2.4) 2.2 (1.9, 2.6) 2.3 (2.0, 2.7) 2.5 (2.1, 3.1)
TOTAL 794 46258
Figure SV10 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Prosthesis Consistency using the
10 Prosthesis Combinations with Lowest 5 Year CPR (Primary Diagnosis OA)
6%
>90% 70-90% vs >90%
70-90%
<70%
5%
<70% vs >90%
0 - 6Mth: HR=1.42 (1.14, 1.78),p=0.002
6Mth+: HR=0.83 (0.64, 1.08),p=0.160

4%
<70% vs 70-90%
3%
2%
1%
0%
0 1 2 3 4 5 6 7 8

>90% 18752 15789 10067 6005 4074 2472 1035
70-90% 16331 13696 9042 4980 3274 1902 726
<70% 11175 9655 6067 3303 2295 1343 525

Reason, 10 Prosthesis Combinations with Lowest 5 Year CPR)
0.16
Overall Proportion
0.12
0.08
0.04
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450
Reason, Excluding 10 Prosthesis Combinations with Lowest 5 Year CPR)
0.16
Overall Proportion
0.12
0.08
0.04
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450

a o a .o rg.au 27
PRIMARY TOTAL KNEE REPLACEMENT

This section provides a similar analysis to the SV14). Further restricting the analysis to revisions
previous section on hip replacement. More performed within two years, the overall
detailed explanation of the analysis is provided proportion revised is 1.8% and the percentage
in that section. of surgeon outliers is 10.3% (Figure SV15).
Individual surgeon variation in revision for any The four most common reasons for revision are:
reason following primary total knee infection, loosening, patellofemoral pain and
replacement, irrespective of prostheses used, pain. The proportion of procedures revised
was assessed. Overall, the proportion of within two years for these four diagnoses are
primary procedures revised is 3.7%. The 0.55%, 0.38%, 0.20% and 0.15%, respectively.
percentage of surgeons who are outliers The percentage of surgeon outliers for each of
(above the upper 99.7% confidence limit) is these revision diagnoses is 5.9%, 5.8%, 5.0% and
8.6% (Figure SV13). 4.4%, respectively.
Limiting this analysis to procedures undertaken Of the 128 surgeon outliers in these four funnel
between 2008 and 2016, the overall proportion plots, 75.8% appear in one, 18.0% appear in
of primary procedures revised is 2.8% and the two, 5.5% appear in three and 0.8% appear in
percentage of surgeon outliers is 10.9% (Figure all four funnel plots (Figures SV16 to SV19).
Figure SV13 Funnel Plot of Primary Total Knee Replacement by Surgeon (Primary Diagnosis OA, Revision for Any Reason)
0.20
Overall Proportion
0.16
0.12
0.08
0.04
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650 2850 3050 3250 3450 3650

Figure SV14 Funnel Plot of Primary Total Knee Replacement by Surgeon performed from 1 January 2008 (Primary Diagnosis OA,
Revision for Any Reason)
0.20
Overall Proportion
0.16
0.12
0.08
0.04
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650 2850 3050 3250 3450
Figure SV15 Funnel Plot of Primary Total Knee Replacement by Surgeon (Primary Diagnosis OA, Revision for Any Reason Within 2
Years)
0.14
Overall Proportion
0.12
0.10
0.08
0.06
0.04
0.02
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650 2850 3050 3250 3450 3650

a o a .o rg.au 29
Figure SV16 Funnel Plot of Primary Total Knee Replacement by Surgeon (Primary Diagnosis OA, Revision for Infection Within 2
Years)
0.08
Overall Proportion
0.06
0.04
0.02
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650 2850 3050 3250 3450 3650
Figure SV17 Funnel Plot of Primary Total Knee Replacement by Surgeon (Primary Diagnosis OA, Revision for Loosening Within 2
Years)
0.08
Overall Proportion
0.06
0.04
0.02
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650 2850 3050 3250 3450 3650

Figure SV18 Funnel Plot of Primary Total Knee Replacement by Surgeon (Primary Diagnosis OA, Revision for Patellofemoral Pain
Within 2 Years)
0.06
Overall Proportion
0.04
0.02
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650 2850 3050 3250 3450 3650
Figure SV19 Funnel Plot of Primary Total Knee Replacement by Surgeon (Primary Diagnosis OA, Revision for Pain Within 2 Years)
0.06
Overall Proportion
0.04
0.02
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650 2850 3050 3250 3450 3650

a o a .o rg.au 31
PROSTHESIS CHOICE
The effect of prosthesis choice on surgeon The rate of revision for the three surgeon
variation following primary total knee groups when only these 10 prosthesis
replacement, was explored. Two approaches combinations were used is reduced for each
were used. The first involved assessing the rate group. However, the <70% group continues to
of revision based on the consistency of have a higher rate of revision compared to the
prosthesis combinations used by a surgeon. other two groups (Table SV8 and Figure SV21).
The second compared the extent of surgeon
variation when only better performing
prosthesis combinations were used.
The role of prosthesis selection was also
evaluated by determining the percentage of
Consistency of Prosthesis Use
surgeon outliers when the 10 prosthesis
Surgeons were divided into three groups based combinations with the lowest five year
on the proportion of procedures in which they cumulative percent revision were used,
used their preferred knee prosthesis compared to when all other prosthesis
combination. Unlike in the hip analysis, the combinations were used. The number of
knee analysis was limited to one rather than surgeon outliers when the 10 prosthesis
two prosthesis combinations. The three groups combinations with the lowest five year
were: >90%, 70-90% and <70%. The number of cumulative percent revision were used, was
surgeons in each group is shown in Table SV5. 1.0% compared to 14.1% when all other
prosthesis combinations were used (Figures
SV22 and SV23). This indicates that the
Table SV5 Number of Surgeons within each Prosthesis
Consistency Group
proportion of surgeon outliers is largely
explained by prosthesis choice.
Prosthesis Consistency N Surgeons
>90% 197
70-90% 227
<70% 353
The proportion of surgeon outliers is largely
The group with least consistency (<70%) had explained by prosthesis choice.
the highest rate of revision compared to the
other two groups (Table SV6 and Figure SV20).
The association between consistency and

preferential selection of prostheses was
examined. The 10 prosthesis combinations with
the lowest cumulative percent revision at five
years and used in at least 1,000 procedures,
were chosen for this analysis. It should be
noted that there are many other prosthesis
combinations with a low rate of revision that
were not included in the analysis. These 10
were chosen simply to test the effect of
prosthesis choice.
Surgeons with less consistency were less likely

to use the 10 prosthesis combinations with the
lowest five year cumulative percent revision
(26.6% compared to 41.7% and 45.7%) (Table
SV7).

Table SV6 Cumulative Percent Revision of Primary Total Knee Replacement by Prosthesis Consistency (Primary Diagnosis OA)
N N
Revised Total
>90% 1492 68443 0.8 (0.7, 0.9) 2.2 (2.1, 2.3) 2.8 (2.7, 3.0) 3.1 (2.9, 3.2) 3.3 (3.1, 3.5) 3.6 (3.4, 3.9)
70-90% 1986 88276 0.9 (0.8, 0.9) 2.2 (2.1, 2.3) 2.9 (2.8, 3.1) 3.2 (3.1, 3.4) 3.6 (3.4, 3.8) 3.8 (3.6, 4.1)
<70% 5042 167545 1.1 (1.1, 1.2) 3.0 (2.9, 3.1) 3.9 (3.8, 4.0) 4.3 (4.2, 4.4) 4.6 (4.5, 4.8) 5.0 (4.8, 5.1)
TOTAL 8520 324264
Figure SV20 Cumulative Percent Revision of Primary Total Knee Replacement by Prosthesis Consistency (Primary Diagnosis
OA)

6%
>90% 70-90% vs >90%
70-90%
<70%
5%
<70% vs >90%
Entire Period: HR=1.34 (1.27, 1.42),p<0.001
4% <70% vs 70-90%
3%
2%
1%
0%
0 1 2 3 4 5 6 7 8

>90% 68443 57540 37701 22155 15275 9207 3895
70-90% 88276 73734 47761 27599 18759 11442 4843
<70% 167545 141131 92340 52646 35917 21351 8817

a o a .o rg.au 33
Table SV7 Primary Total Knee Replacement by Prosthesis Consistency and Prosthesis Used (Primary Diagnosis OA)
10 Prosthesis Combinations with

Other Prostheses TOTAL
Lowest 5 Year CPR
Prosthesis Consistency N Row% N Row% N Row%
>90% 31245 45.7 37198 54.3 68443 100.0
70-90% 36770 41.7 51506 58.3 88276 100.0
<70% 44638 26.6 122907 73.4 167545 100.0
TOTAL 112653 34.7 211611 65.3 324264 100.0
Table SV8 Cumulative Percent Revision of Primary Total Knee Replacement by Prosthesis Consistency using the 10 Prosthesis
Combinations with Lowest 5 Year CPR (Primary Diagnosis OA)
N N
Revised Total
>90% 526 31245 0.7 (0.6, 0.8) 1.7 (1.6, 1.9) 2.2 (2.0, 2.4) 2.4 (2.2, 2.6) 2.6 (2.3, 2.8) 2.8 (2.5, 3.1)
70-90% 570 36770 0.6 (0.6, 0.7) 1.6 (1.4, 1.7) 2.1 (1.9, 2.3) 2.3 (2.1, 2.5) 2.4 (2.2, 2.7) 2.6 (2.3, 2.9)
<70% 937 44638 0.9 (0.8, 1.0) 2.2 (2.0, 2.3) 2.7 (2.5, 2.8) 3.0 (2.8, 3.2) 3.3 (3.1, 3.6) 3.4 (3.2, 3.7)
TOTAL 2033 112653
Figure SV21 Cumulative Percent Revision of Primary Total Knee Replacement by Prosthesis Consistency using the 10
Prosthesis Combinations with Lowest 5 Year CPR (Primary Diagnosis OA)

6%
>90% >90% vs 70-90%
70-90%
<70%
5%
<70% vs 70-90%
4% <70% vs >90%
3%
2%
1%
0%
0 1 2 3 4 5 6 7 8

>90% 31245 25826 16493 9480 6426 3813 1526
70-90% 36770 30675 19528 10468 6655 3715 1467
<70% 44638 37775 24185 11929 7444 4186 1579

Figure SV22 Funnel Plot of Primary Total Knee Replacement by Surgeon (Primary Diagnosis OA, Revision for Any Reason,
Excluding 10 Prosthesis Combinations with Lowest 5 Year CPR)
0.20
Overall Proportion
0.15
0.10
0.05
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650 2850
Figure SV23 Funnel Plot of Primary Total Knee Replacement by Surgeon (Primary Diagnosis OA, Revision for Any Reason, 10
Prosthesis Combinations with Lowest 5 Year CPR)
0.20
Overall Proportion
0.15
0.10
0.05
0.00
50 250 450 650 850 1050 1250 1450 1650 1850 2050 2250 2450 2650 2850

a o a .o rg.au 35
HOSPITAL VARIATION
The Registry assessed whether there was Use of Better Performing Prostheses
variation in revision for both primary total
The difference in the rate of revision between
conventional hip and primary total knee
public and private hospitals was further
replacement when individual hospitals were
explored by restricting the analysis to the 10
compared. Only hospitals with 50 or more
prosthesis combinations with the lowest
procedures were included.
cumulative percentage revision at five years
and used in at least 1,000 procedures. The
In addition, the rates of revision for public and
number of prosthesis combinations (10) was
private hospitals were also compared. There
chosen to examine the effect of prosthesis
are many potential factors that may influence
choice. As mentioned previously in the section
these rates. These include differences in
on surgeon variation, there are many other
patient characteristics, patient expectations,
prosthesis combinations with a similar low rate
access to healthcare, prostheses used, and
of revision.
variation in surgeon experience and training.
Many of these factors cannot be controlled for
For procedures undertaken for osteoarthritis
in this type of comparative analysis. One factor
using only the 10 prosthesis combinations with
that can be controlled for is prosthesis choice.
the lowest cumulative percent revision at five
As this was identified as an important factor in
years, there is a lower rate of revision in private
surgeon variation, an analysis was undertaken
hospitals in the first month, and no difference
to determine if prosthesis choice had an effect
after that time (Table SV11 and Figure SV27).
on the rate of revision in public and private
hospitals.
For procedures undertaken for fractured neck
of femur using only the 10 prosthesis
PRIMARY TOTAL CONVENTIONAL HIP combinations with the lowest cumulative
REPLACEMENT percent revision at five years, there is no
difference in the rate of revision between
Variation in revision between hospitals
private and public hospitals (Table SV12 and
following primary total conventional hip
Figure SV28).
replacement for osteoarthritis was assessed.
The percentage of hospital outliers (above the
These results suggest that the difference in the
upper 99.7% confidence limit) is 11.5% (Figure
rate of revision between public and private
SV24).
hospitals is largely due to prosthesis choice.
The rate of revision following primary total
conventional hip replacement (for
osteoarthritis and fractured neck of femur
The difference in rates of revision between
separately) undertaken in public and private
public and private hospitals is largely due to
hospital groups was also compared.
prosthesis choice.
For those procedures undertaken for
osteoarthritis, private hospitals have a higher
rate of revision after three months (Table SV9
and Figure SV25).
This difference was also evident when primary

total conventional hip replacement was
undertaken for fractured neck of femur (Table
SV10 and Figure SV26).

Figure SV24 Funnel plot of Primary Total Conventional Hip Replacement by Hospital (Primary Diagnosis OA, Revision for Any
Reason)
0.20
Overall Proportion
0.16
0.12
0.08
0.04
0.00
50 550 1050 1550 2050 2550 3050 3550 4050 4550 5050 5550 6050 6550 7050 7550 8050 8550

a o a .o rg.au 37
Table SV9 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Hospital Type (Primary Diagnosis
OA)
N N
Hospital Type 1 Yr 3 Yrs 5 Yrs 7 Yrs 10 Yrs 13 Yrs
Revised Total
Private Hospital 8910 210828 1.6 (1.5, 1.7) 2.7 (2.6, 2.8) 3.9 (3.8, 4.0) 5.2 (5.1, 5.3) 7.0 (6.8, 7.1) 8.7 (8.4, 8.9)
Public Hospital 3609 100931 1.5 (1.4, 1.6) 2.4 (2.3, 2.5) 3.2 (3.0, 3.3) 4.2 (4.0, 4.3) 5.5 (5.3, 5.7) 6.9 (6.6, 7.3)
TOTAL 12519 311759
Figure SV25 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Hospital Type (Primary
Diagnosis OA)

20%
Private Hospital
Private Hospital vs Public Hospital
Public Hospital
18% 0 - 2Wk: HR=1.07 (0.92, 1.23),p=0.385
2Wk - 1Mth: HR=0.89 (0.79, 1.00),p=0.053

16%
1Mth - 3Mth: HR=1.10 (0.97, 1.24),p=0.128
14% 3Mth+: HR=1.31 (1.25, 1.37),p<0.001

12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13

Private Hospital 210828 184220 138555 99366 66029 29927 5808
Public Hospital 100931 88836 68381 50871 34854 16112 3098

Table SV10 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Hospital Type (Primary Diagnosis
Fractured NOF)
N N
Revised Total
Public Hospital 413 9484 2.7 (2.4, 3.1) 4.2 (3.8, 4.7) 5.0 (4.5, 5.6) 6.0 (5.4, 6.7) 7.4 (6.5, 8.5) 8.3 (7.0, 9.8)
TOTAL 767 15602
Figure SV26 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Hospital Type (Primary
Diagnosis Fractured NOF)

20%
Private Hospital
Public Hospital
18% Entire Period: HR=1.40 (1.21, 1.61),p<0.001
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13

Public Hospital 9484 7467 4846 2975 1634 497 71

a o a .o rg.au 39
Table SV11 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Hospital Type using the 10
Prosthesis Combinations with Lowest 5 year CPR (Primary Diagnosis OA)
N N
Revised Total
Public Hospital 654 27522 1.1 (1.0, 1.3) 1.7 (1.6, 1.9) 2.2 (2.0, 2.4) 2.7 (2.5, 2.9) 3.4 (3.1, 3.7) 4.3 (3.8, 4.8)
TOTAL 1802 72431
Figure SV27 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Hospital Type using the 10
Prosthesis Combinations with Lowest 5 year CPR (Primary Diagnosis OA)
20%
Private Hospital
Public Hospital
18% 0 - 1Mth: HR=0.75 (0.60, 0.94),p=0.013
1Mth+: HR=1.09 (0.98, 1.21),p=0.115

16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13

Public Hospital 27522 24372 18710 14103 9953 4738 730

Table SV12 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Hospital Type using the 10
Prosthesis Combinations with Lowest 5 year CPR (Primary Diagnosis Fractured NOF)
N N
Revised Total
Private Hospital 59 1634 1.9 (1.3, 2.7) 3.0 (2.2, 4.1) 4.1 (3.1, 5.4) 5.5 (4.2, 7.4) 6.4 (4.7, 8.8)
Public Hospital 129 3688 2.3 (1.9, 2.9) 3.5 (2.9, 4.2) 3.8 (3.2, 4.6) 4.7 (3.9, 5.7) 5.2 (4.2, 6.6)
TOTAL 188 5322
Figure SV28 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Hospital Type using the 10
Prosthesis Combinations with Lowest 5 year CPR (Primary Diagnosis Fractured NOF)

20%
Private Hospital Private Hospital vs Public Hospital
Public Hospital
18% Entire Period: HR=1.00 (0.73, 1.37),p=0.999
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12

Public Hospital 3688 2927 1918 1191 631 158 19

a o a .o rg.au 41

Variation in revision between hospitals procedures performed using only the 10
following primary total knee replacement for prosthesis combinations with the lowest
osteoarthritis was assessed. The percentage of cumulative percentage revision at five years
hospital outliers (above the upper 99.7% and used in at least 1,000 procedures. In this
confidence limit) is 15.2% (Figure SV29). analysis, private hospitals have a lower rate of
revision in the first three months and after 1.5
The rate of revision following primary total knee years (Table SV14 and Figure SV31).
replacement for osteoarthritis, undertaken in
public and private hospital groups, was also As with primary total conventional hip
compared. Private hospitals have a higher rate replacement, it appears that the difference in
of revision after four years (Table SV13 and rate of revision between private and public
Figure SV30). hospitals is largely due to prosthesis choice.

The difference in the rate of revision was further
explored by comparing the outcomes of all
Figure SV29 Funnel plot of Primary Total Knee Replacement by Hospital (Primary Diagnosis OA, Revision for Any Reason)
0.20
Overall Proportion
0.16
0.12
0.08
0.04
0.00
50 1050 2050 3050 4050 5050 6050 7050 8050 9050 10050 11050 12050 13050 14050

Table SV13 Cumulative Percent Revision of Primary Total Knee Replacement by Hospital Type (Primary Diagnosis OA)
N N
Revised Total
Public Hospital 5151 160642 0.9 (0.9, 1.0) 2.5 (2.5, 2.6) 3.3 (3.2, 3.4) 4.0 (3.9, 4.1) 4.7 (4.6, 4.9) 5.6 (5.4, 5.8)
TOTAL 17262 498901
Figure SV30 Cumulative Percent Revision of Primary Total Knee Replacement by Hospital Type (Primary Diagnosis OA)

20%
Private Hospital
Public Hospital
18% 0 - 6Mth: HR=0.87 (0.80, 0.95),p=0.001
6Mth - 1Yr: HR=1.34 (1.22, 1.47),p<0.001

16%
1Yr - 1.5Yr: HR=1.21 (1.11, 1.32),p<0.001
14% 1.5Yr - 2.5Yr: HR=1.00 (0.93, 1.08),p=0.925

2.5Yr - 3Yr: HR=0.90 (0.79, 1.03),p=0.125

12% 3Yr - 4Yr: HR=1.04 (0.93, 1.16),p=0.482
4Yr+: HR=1.24 (1.16, 1.33),p<0.001
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13

Public Hospital 160642 142391 108647 79446 53476 23973 4106

a o a .o rg.au 43
Table SV14 Cumulative Percent Revision of Primary Total Knee Replacement by Hospital Type using the 10 Prosthesis
Combinations with Lowest 5 year CPR (Primary Diagnosis OA)
N N
Revised Total
Public Hospital 1131 53865 0.8 (0.7, 0.9) 1.9 (1.8, 2.1) 2.4 (2.3, 2.6) 2.9 (2.8, 3.1) 3.6 (3.3, 3.8) 4.0 (3.6, 4.4)
TOTAL 3148 153566
Figure SV31 Cumulative Percent Revision of Primary Total Knee Replacement by Hospital Type using the 10 Prosthesis
Combinations with Lowest 5 year CPR (Primary Diagnosis OA)
20%
Private Hospital
Public Hospital
18% 0 - 3Mth: HR=0.60 (0.50, 0.74),p<0.001
3Mth - 1.5Yr: HR=1.07 (0.95, 1.21),p=0.244

16%
1.5Yr+: HR=0.89 (0.81, 0.99),p=0.033
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13

Public Hospital 53865 45733 32051 20045 11197 4344 722

Ten and Fifteen Year Prosthesis Outcomes

TEN YEAR OUTCOMES
The Registry first reported 10 year outcomes in The 10 year cumulative percent revision for the
2011. Since that time, the Registry has reported prosthesis combinations ranges from 1.9% to
on an increasing number of hip and knee 45.8%. A commonly accepted benchmark
prostheses that have achieved this length of standard is a 5% cumulative percent revision
follow up. This outcome is widely regarded as at 10 years. There are 35 (44.9%) hip prosthesis
an important milestone in assessing the combinations with a 10 year cumulative rate
performance of prostheses. of revision (for any reason) of less than 5.0%.
These are indicated in bold text in Table TY1.
This year, the number of individual
combinations of femoral and acetabular hip Recently, an international working group
prostheses with 10 year outcomes has reviewed approaches to benchmarking hip
increased by 9.9% and the number of and knee prostheses. An important
individual combinations of femoral and tibial recommendation was to use confidence
knee prostheses has increased by 21.7%. intervals (CIs) rather than the rate of revision as
used above. The reason for this is that data
quality is inherently reflected in the CIs. To
HIP REPLACEMENT identify better performing prosthesis
combinations, the following two approaches
Individual femoral and acetabular prosthesis
were recommended:
combinations are reported. A combination is
included if more than 350 procedures have
Superiority approach: the upper CI is less than,
been reported and the follow up period is 10
or equal to, the benchmark standard. If the
or more years.
benchmark is 5% at 10 years, then 15 (19.2%)
hip prosthesis combinations would qualify for
When combinations include a variety of
the superiority benchmark.
bearing surfaces, large head metal/metal
surfaces have been reported separately.
Non-inferiority approach: the permitted upper
CI level is 20% above the benchmark
There are 78 femoral and acetabular
standard. For the benchmark standard of 5%
combinations with 10 year outcome data. This
at 10 years, the accepted upper CI is 6% or
is seven more than last year. These prosthesis
less. Using this approach, an additional 11
combinations account for 61.8% of all primary
prosthesis combinations can be benchmarked
total conventional hip procedures for
i.e. 26 (33.3%) prosthesis combinations would
osteoarthritis. Of these 78 combinations, 36
receive a non-inferiority benchmark.
were not used in 2016. These 36 combinations
account for 8.0% of all primary total
conventional hip procedures.

a o a .o rg.au 45
Table TY1 Cumulative Percent Revision of Primary Total Conventional Hip Replacement Combinations with 10 Year Data
(Primary Diagnosis OA)
Type of Revision
Femoral Acetabular N N
THR Femoral Acetabular Other 1 Yr 5 Yrs 10 Yrs
Stem Component Revised Total
ABGII ABGII 237 2755 31 116 60 30 1.7 (1.3, 2.3) 4.1 (3.4, 4.9) 6.9 (6.0, 8.0)
ABGII ABGII (Shell/Insert) 57 841 11 32 10 4 1.4 (0.8, 2.5) 2.8 (1.9, 4.2) 6.5 (4.9, 8.7)
ABGII Trident (Shell) 183 2383 9 111 23 40 2.6 (2.0, 3.3) 4.9 (4.1, 5.9) 8.5 (7.3, 10.0)
Accolade I Trident (Shell) 413 8521 47 162 81 123 1.7 (1.4, 2.0) 3.8 (3.4, 4.2) 5.8 (5.2, 6.4)
Adapter Bionik MoM
* 81 376 11 8 21 41 3.5 (2.0, 5.9) 15.3 (12.0, 19.5) 23.5 (19.3, 28.4)
Alloclassic Allofit 215 4914 24 83 43 65 1.2 (0.9, 1.5) 2.8 (2.3, 3.3) 4.9 (4.2, 5.6)
Alloclassic DuromMoM* 80 547 21 12 37 10 1.3 (0.6, 2.7) 7.4 (5.5, 10.0) 16.3 (13.1, 20.2)
Alloclassic Fitmore 118 1709 12 60 12 34 3.3 (2.5, 4.3) 5.8 (4.7, 7.0) 7.7 (6.4, 9.2)
Alloclassic Metasul* 20 371 3 2 10 5 0.8 (0.3, 2.5) 3.6 (2.1, 6.1) 4.8 (3.0, 7.7)
Alloclassic Trabecular Metal (Shell) 36 957 2 11 4 19 2.3 (1.5, 3.5) 3.7 (2.6, 5.2) 4.2 (3.0, 5.9)
Alloclassic Trilogy 10 833 . 7 1 2 0.4 (0.1, 1.1) 0.5 (0.2, 1.4) 2.4 (1.2, 4.8)
Anthology Reflection (Shell) 34 908 3 12 11 8 2.0 (1.3, 3.2) 3.2 (2.2, 4.6) 4.6 (3.2, 6.5)
Apex Fin II* 38 923 4 8 14 12 1.7 (1.1, 2.8) 3.6 (2.5, 5.1) 5.4 (3.9, 7.5)
C-Stem Duraloc* 70 894 9 17 11 33 2.0 (1.3, 3.2) 3.8 (2.7, 5.3) 7.0 (5.4, 9.0)
C-Stem Elite Plus LPW* 19 367 9 4 6 . 0.6 (0.1, 2.2) 2.7 (1.4, 5.0) 5.4 (3.3, 8.8)
C-Stem Pinnacle 24 760 1 10 5 8 1.7 (1.0, 3.0) 2.8 (1.8, 4.3) 4.0 (2.6, 6.2)
CLS Allofit 48 800 5 26 11 6 1.4 (0.8, 2.5) 3.9 (2.7, 5.5) 6.4 (4.7, 8.6)
CLS Fitmore 46 712 5 21 7 13 2.0 (1.2, 3.3) 4.8 (3.4, 6.8) 6.2 (4.5, 8.5)
CPCS Reflection (Cup) 51 716 18 2 20 11 0.6 (0.2, 1.5) 2.5 (1.5, 4.1) 8.8 (6.3, 12.2)
CPCS Reflection (Shell) 67 2616 6 27 10 24 0.8 (0.5, 1.2) 1.6 (1.2, 2.2) 3.6 (2.7, 4.7)
CPT Allofit 21 1027 3 9 . 9 0.8 (0.4, 1.6) 2.7 (1.7, 4.1) 3.1 (1.9, 5.0)
CPT Trabecular Metal (Shell) 50 1275 4 22 8 16 1.7 (1.1, 2.6) 4.1 (3.0, 5.6) 6.5 (4.7, 9.0)
CPT Trilogy 246 6962 22 74 33 117 1.6 (1.3, 1.9) 3.2 (2.8, 3.7) 4.8 (4.1, 5.5)
CPT ZCA 29 780 10 5 8 6 0.5 (0.2, 1.4) 2.4 (1.4, 3.8) 4.7 (3.1, 7.2)
Charnley Charnley Ogee* 54 630 31 7 4 12 1.1 (0.5, 2.3) 4.9 (3.5, 7.0) 8.1 (6.1, 10.8)
Charnley Charnley* 39 563 30 6 3 . 0.5 (0.2, 1.7) 2.2 (1.3, 3.9) 6.5 (4.5, 9.4)
Charnley Vitalock* 35 370 5 17 2 11 1.9 (0.9, 3.9) 4.4 (2.7, 7.1) 7.9 (5.5, 11.4)
Citation Trident (Shell)* 42 1035 3 9 11 19 1.7 (1.1, 2.8) 3.2 (2.3, 4.5) 3.9 (2.9, 5.3)
Citation Vitalock* 34 508 2 5 11 16 0.4 (0.1, 1.6) 2.0 (1.1, 3.7) 5.0 (3.3, 7.4)
Corail ASRMoM* 1113 2653 196 37 837 43 2.0 (1.6, 2.7) 27.3 (25.6, 29.0) 45.8 (43.7, 48.0)
Corail Duraloc* 64 1267 7 30 11 16 1.0 (0.6, 1.8) 2.5 (1.8, 3.6) 5.7 (4.3, 7.4)
Corail Pinnacle 942 34210 82 314 155 391 1.6 (1.5, 1.8) 3.1 (2.9, 3.3) 5.2 (4.6, 5.8)
Corail PinnacleMoM* 94 880 14 31 17 32 2.3 (1.5, 3.5) 6.1 (4.7, 8.0) 13.0 (10.4, 16.1)
Elite Plus Duraloc* 97 953 14 57 6 20 1.6 (1.0, 2.6) 5.1 (3.9, 6.8) 8.8 (7.0, 10.9)
Epoch Trilogy* 42 990 1 9 7 25 2.4 (1.6, 3.6) 3.6 (2.6, 4.9) 4.4 (3.2, 6.0)
Exeter Contemporary* 35 427 8 6 13 8 1.9 (1.0, 3.8) 4.2 (2.6, 6.6) 6.0 (4.0, 8.9)
Exeter Vitalock* 58 1076 7 10 23 18 1.4 (0.8, 2.3) 2.3 (1.5, 3.4) 4.6 (3.4, 6.1)
Exeter V40 ABGII 34 973 8 12 8 6 0.8 (0.4, 1.7) 1.6 (1.0, 2.7) 3.4 (2.3, 4.8)
Exeter V40 Contemporary 215 4398 48 38 98 31 1.4 (1.1, 1.8) 3.3 (2.8, 3.9) 5.8 (5.0, 6.7)
Exeter V40 Exeter Contemporary 112 2821 32 28 31 21 1.4 (1.0, 1.9) 2.9 (2.3, 3.6) 4.5 (3.7, 5.5)
Exeter V40 Exeter* 73 1526 12 14 30 17 0.9 (0.5, 1.5) 2.9 (2.1, 3.9) 4.5 (3.5, 5.8)
Exeter V40 Hemispherical 24 655 6 5 1 12 1.8 (1.1, 3.2) 3.1 (2.0, 4.8) 5.0 (3.2, 7.8)
Exeter V40 Mallory-Head 32 1347 3 20 2 7 0.5 (0.3, 1.1) 1.1 (0.6, 1.8) 2.8 (1.9, 4.2)
Exeter V40 Pinnacle 31 1296 1 12 8 10 1.4 (0.9, 2.3) 2.3 (1.6, 3.5) 6.2 (3.1, 12.0)
Exeter V40 Trident (Shell) 1083 45826 143 319 161 460 1.1 (1.0, 1.2) 2.3 (2.1, 2.4) 3.7 (3.5, 4.0)
Exeter V40 Trilogy* 18 516 2 5 2 9 1.9 (1.0, 3.6) 2.5 (1.5, 4.3) 4.2 (2.5, 6.9)
Exeter V40 Vitalock* 66 1795 14 19 19 14 0.8 (0.5, 1.4) 2.3 (1.7, 3.1) 3.2 (2.5, 4.2)

Type of Revision
THR Femoral Acetabular Other 1 Yr 5 Yrs 10 Yrs
F2L SPH-Blind* 53 571 6 19 15 13 2.8 (1.7, 4.5) 6.1 (4.4, 8.4) 7.6 (5.7, 10.2)
M/L Taper Trilogy 20 686 . 4 6 10 1.3 (0.7, 2.5) 2.8 (1.7, 4.6) 4.2 (2.6, 6.6)
MS 30 Allofit 49 1473 8 16 14 11 1.2 (0.7, 1.9) 2.2 (1.5, 3.1) 3.5 (2.6, 4.9)
MS 30 Fitmore 19 572 1 4 7 7 0.4 (0.1, 1.4) 1.5 (0.7, 3.2) 2.8 (1.5, 5.1)
MS 30 Low Profile Cup 14 594 5 2 6 1 0.3 (0.1, 1.4) 1.0 (0.4, 2.3) 2.4 (1.3, 4.4)
Mallory-Head Mallory-Head 156 2863 13 13 50 80 1.8 (1.4, 2.4) 3.0 (2.4, 3.7) 4.9 (4.1, 5.9)
Mallory-Head RecapMoM* 26 395 6 . 18 2 1.0 (0.4, 2.7) 2.6 (1.4, 4.7) 6.8 (4.4, 10.4)
Meridian Vitalock* 29 354 2 2 12 13 0.9 (0.3, 2.6) 3.5 (2.0, 6.1) 6.4 (4.2, 9.6)
Natural Hip Allofit* 10 529 . 3 3 4 0.8 (0.3, 2.0) 1.1 (0.5, 2.5) 1.9 (1.0, 3.6)
Natural Hip Fitmore* 35 882 2 5 11 17 0.5 (0.2, 1.2) 2.0 (1.3, 3.2) 4.1 (2.9, 5.9)
Omnifit Secur-Fit* 77 716 7 21 17 32 2.4 (1.5, 3.8) 6.2 (4.6, 8.2) 9.9 (7.9, 12.5)
Omnifit Trident (Shell) 134 3613 12 31 22 69 1.7 (1.3, 2.2) 3.1 (2.5, 3.7) 3.9 (3.3, 4.7)
S-Rom Duraloc Option* 25 523 4 9 5 7 1.7 (0.9, 3.3) 3.3 (2.1, 5.2) 4.6 (3.1, 6.8)
S-Rom Pinnacle 97 2249 8 58 8 23 2.1 (1.6, 2.8) 3.9 (3.1, 4.8) 5.2 (4.2, 6.4)
SL-Plus EP-Fit Plus 102 2062 5 45 20 32 1.6 (1.1, 2.2) 3.5 (2.8, 4.4) 5.6 (4.6, 6.9)
Secur-Fit Trident (Shell) 303 8524 22 128 56 97 1.6 (1.3, 1.9) 3.3 (2.9, 3.7) 4.4 (3.9, 5.0)
Secur-Fit Plus Trident (Shell) 155 5333 12 40 35 68 1.1 (0.9, 1.4) 2.2 (1.8, 2.6) 3.1 (2.6, 3.7)
Spectron EF BHR MoM
* 45 430 9 . 32 4 0.9 (0.4, 2.5) 6.0 (4.1, 8.8) 13.9 (10.2, 18.8)
Spectron EF Reflection (Cup) 104 1398 36 10 49 9 1.0 (0.6, 1.7) 2.8 (2.1, 3.9) 7.2 (5.7, 9.0)
Spectron EF Reflection (Shell) 243 4584 52 79 37 75 1.0 (0.7, 1.3) 2.7 (2.2, 3.2) 5.5 (4.7, 6.3)
Stability Duraloc* 44 374 1 9 13 21 0.5 (0.1, 2.1) 2.2 (1.1, 4.3) 8.9 (6.3, 12.5)
Summit ASRMoM* 426 1041 14 6 384 22 1.1 (0.6, 1.9) 19.6 (17.3, 22.2) 44.0 (40.8, 47.4)
Summit Pinnacle 90 4115 6 19 14 51 1.1 (0.9, 1.5) 2.0 (1.6, 2.5) 3.1 (2.4, 4.1)
Summit PinnacleMoM* 59 730 3 5 10 41 1.4 (0.7, 2.5) 3.4 (2.3, 5.0) 9.0 (6.9, 11.5)
Synergy BHRMoM* 73 698 4 5 46 18 1.4 (0.8, 2.6) 4.8 (3.4, 6.7) 12.3 (9.8, 15.5)
Synergy Reflection (Shell) 299 7314 26 61 99 113 1.5 (1.3, 1.8) 2.6 (2.3, 3.0) 3.9 (3.4, 4.4)
Synergy Trident (Shell)* 13 438 . 3 4 6 0.9 (0.3, 2.4) 1.9 (0.9, 3.7) 4.5 (2.5, 8.2)
Taperloc M2aMoM* 54 471 11 2 38 3 1.5 (0.7, 3.1) 6.9 (4.9, 9.6) 12.2 (9.4, 15.8)
Taperloc Mallory-Head 69 1657 6 15 24 24 1.9 (1.3, 2.7) 3.1 (2.3, 4.2) 5.6 (4.3, 7.3)
Taperloc RecapMoM* 40 456 10 5 20 5 2.0 (1.0, 3.8) 5.6 (3.8, 8.2) 9.7 (7.2, 13.0)
VerSys Trilogy 203 4363 13 71 36 83 2.5 (2.1, 3.0) 3.7 (3.2, 4.4) 4.9 (4.2, 5.6)
TOTAL 9596 209670 1243 2541 3017 2795
Note: Only combinations with over 350 procedures have been listed
MoM
denotes metal/metal prosthesis combinations used with head size larger than 32mm
* denotes prosthesis combinations with no reported use in primary total conventional hip replacement in 2016

a o a .o rg.au 47
KNEE REPLACEMENT
Individual femoral and tibial prosthesis osteoarthritis. Of these 56 prosthesis
combinations are reported. A combination is combinations, 18 were not used in 2016. These
included if more than 350 procedures have 18 account for 10.6% of all primary total knee
been reported to the Registry and the follow up procedures.
is 10 or more years.
The 10 year cumulative percent revision ranges
The listed prostheses most often represent a from 3.0% to 13.1%. There are 16 knee prosthesis
family of devices that have a range of different combinations (28.6%) with a 10 year cumulative
femoral and tibial components, combined with percent revision (for any reason) of less than
different tibial inserts, listed under one prosthesis 5.0%. These are indicated in bold text in Table
name. Prosthesis types are separated as to TY2.
whether they are minimally or posteriorly
stabilised. Applying the recommendations of the
international benchmarking working group,
There are 56 total knee replacement nine (16.1%) knee prosthesis combinations
combinations with 10 year outcome data; 10 would qualify for a superiority benchmark and
more than last year. These prosthesis 25 (44.6%) would qualify for a non-inferiority
combinations account for 84.8% of all primary benchmark.
total knee replacement procedures for
Table TY2 Cumulative Percent Revision of Primary Total Knee Replacement Combinations with 10 Year Data (Primary Diagnosis
OA)
Type of Revision
Femoral Tibial N N
TKR Femoral Tibial Other 1 Yr 5 Yrs 10 Yrs
Component Component Revised Total
AGC AGC 245 5026 90 5 25 125 0.5 (0.4, 0.8) 3.1 (2.7, 3.7) 4.9 (4.3, 5.7)
Active Knee Active Knee 527 8533 148 25 36 318 1.1 (0.9, 1.3) 4.9 (4.4, 5.4) 8.0 (7.3, 8.8)
Advance Advance 33 741 9 1 8 15 2.1 (1.2, 3.5) 4.6 (3.2, 6.6) 8.0 (4.9, 13.0)
Advance Advance II 96 1596 32 2 13 49 1.6 (1.1, 2.3) 4.9 (3.9, 6.1) 6.9 (5.7, 8.5)
Advantim Advantim* 61 1454 28 3 3 27 0.7 (0.4, 1.3) 3.1 (2.3, 4.1) 4.7 (3.6, 6.2)
BalanSys BalanSys 33 2277 8 3 3 19 0.4 (0.2, 0.8) 2.3 (1.5, 3.4) 4.3 (2.7, 7.0)
Columbus Columbus 90 1174 27 4 5 54 1.9 (1.2, 2.9) 7.6 (6.1, 9.4) 11.6 (9.1, 14.6)
Duracon Duracon* 1044 19830 251 29 67 697 1.1 (1.0, 1.3) 3.4 (3.2, 3.7) 5.0 (4.7, 5.3)
Genesis II CR Genesis II 760 20944 144 49 49 518 0.9 (0.8, 1.1) 3.4 (3.2, 3.7) 4.7 (4.3, 5.0)
Genesis II CR Profix Mobile* 100 1209 38 9 7 46 1.9 (1.3, 2.9) 5.4 (4.2, 6.9) 7.9 (6.4, 9.7)
Genesis II Oxinium CR (ct Genesis II 354 7468 60 23 22 249 1.0 (0.8, 1.3) 3.7 (3.3, 4.2) 6.2 (5.6, 7.0)
Genesis II Oxinium PS (ct Genesis II 785 15524 92 26 129 538 1.5 (1.4, 1.8) 5.3 (4.9, 5.7) 7.6 (7.0, 8.2)
Genesis II PS Genesis II 631 16463 96 26 45 464 1.3 (1.1, 1.4) 3.8 (3.5, 4.1) 5.3 (4.8, 5.8)
Journey Oxinium Journey* 243 2975 37 5 26 175 1.4 (1.0, 1.9) 6.5 (5.6, 7.5) 11.1 (9.5, 12.9)
Kinemax Plus Kinemax Plus* 112 1815 64 3 5 40 0.9 (0.6, 1.5) 3.2 (2.4, 4.1) 4.7 (3.8, 5.8)
LCS CR LCS 554 8301 221 23 84 226 1.1 (0.9, 1.3) 4.4 (4.0, 4.9) 6.2 (5.7, 6.8)
LCS CR MBT 879 25962 282 41 118 438 0.9 (0.8, 1.0) 3.5 (3.3, 3.8) 5.0 (4.6, 5.3)
LCS CR MBT Duofix 605 13412 164 26 38 377 1.3 (1.1, 1.5) 4.1 (3.8, 4.5) 5.4 (5.0, 5.9)
LCS Duofix MBT Duofix* 445 3605 323 27 7 88 1.6 (1.2, 2.1) 10.2 (9.2, 11.2) 13.1 (12.0, 14.3)
LCS Duofix MBT* 126 1170 88 10 2 26 1.1 (0.6, 1.9) 7.9 (6.5, 9.7) 12.2 (10.2, 14.5)
MBK (Zimmer) Nexgen* 30 448 16 1 1 12 0.9 (0.3, 2.4) 4.1 (2.6, 6.5) 5.9 (4.0, 8.6)
Maxim Maxim* 172 2447 53 15 12 92 1.1 (0.7, 1.6) 4.0 (3.3, 4.8) 6.0 (5.1, 7.1)
Natural Knee II Natural Knee II* 357 6443 144 8 58 147 0.9 (0.7, 1.2) 2.8 (2.4, 3.2) 5.3 (4.7, 6.0)
Nexgen CR Nexgen 332 10977 103 14 31 184 0.5 (0.4, 0.7) 2.1 (1.8, 2.3) 3.1 (2.7, 3.4)
Nexgen CR Nexgen TM CR 43 793 14 3 8 18 1.3 (0.7, 2.4) 5.4 (3.9, 7.3) 6.1 (4.5, 8.2)
Nexgen CR Flex Nexgen 795 42126 159 59 89 488 0.8 (0.7, 0.9) 2.3 (2.1, 2.4) 3.1 (2.8, 3.3)

Type of Revision
Femoral Tibial N N
TKR Femoral Tibial Other 1 Yr 5 Yrs 10 Yrs
Nexgen CR Flex Nexgen TM CR 211 9571 60 18 22 111 0.5 (0.4, 0.7) 2.3 (2.0, 2.7) 3.3 (2.8, 3.9)
Nexgen LPS Nexgen 289 6591 69 19 32 169 1.0 (0.8, 1.2) 3.2 (2.8, 3.7) 5.1 (4.5, 5.7)
Nexgen LPS Nexgen TM LPS 26 1116 6 2 5 13 0.8 (0.4, 1.6) 2.7 (1.8, 4.0) 3.3 (2.1, 4.9)
Nexgen LPS Flex Nexgen 979 30278 239 51 166 523 0.9 (0.8, 1.1) 3.2 (3.0, 3.5) 5.1 (4.8, 5.5)
Nexgen LPS Flex Nexgen TM LPS 41 1432 21 . 4 16 1.0 (0.6, 1.7) 3.0 (2.2, 4.1) 3.6 (2.6, 4.9)
Optetrak-CR Optetrak 41 966 10 6 4 21 1.5 (0.8, 2.6) 5.4 (3.8, 7.7) 8.2 (5.9, 11.3)
Optetrak-PS Optetrak 191 2729 67 4 26 94 1.4 (1.0, 1.9) 6.3 (5.4, 7.4) 9.9 (8.5, 11.5)
Optetrak-PS Optetrak-RBK 68 939 16 2 3 47 2.0 (1.2, 3.1) 6.8 (5.2, 8.8) 10.9 (8.3, 14.4)
PFC Sigma CR AMK Duofix* 53 1890 17 . 1 35 0.7 (0.4, 1.2) 2.3 (1.7, 3.1) 3.0 (2.2, 4.0)
PFC Sigma CR MBT 257 5742 38 30 42 147 1.4 (1.1, 1.7) 4.1 (3.6, 4.7) 5.2 (4.6, 5.9)
PFC Sigma CR MBT Duofix 115 2544 14 16 3 82 1.2 (0.9, 1.7) 4.3 (3.5, 5.2) 5.7 (4.6, 7.1)
PFC Sigma CR PFC Sigma 599 22644 124 45 53 377 0.7 (0.6, 0.9) 2.4 (2.2, 2.6) 3.5 (3.2, 3.8)
PFC Sigma PS MBT 241 6161 70 12 19 140 0.9 (0.7, 1.2) 3.6 (3.1, 4.1) 4.9 (4.2, 5.6)
PFC Sigma PS MBT Duofix 131 1886 19 4 4 104 1.8 (1.2, 2.5) 6.9 (5.8, 8.3) 8.9 (7.5, 10.5)
PFC Sigma PS PFC Sigma 263 7317 82 8 22 151 1.2 (0.9, 1.5) 3.2 (2.8, 3.7) 4.7 (4.1, 5.4)
Profix Profix Mobile* 102 986 32 6 5 59 2.3 (1.6, 3.5) 8.2 (6.6, 10.1) 9.8 (8.0, 11.9)
Profix Profix* 259 5370 55 13 18 173 1.0 (0.8, 1.4) 3.7 (3.2, 4.3) 5.1 (4.6, 5.8)
Profix Oxinium (ctd) Profix* 92 1049 20 4 14 54 2.1 (1.4, 3.2) 7.0 (5.6, 8.7) 8.5 (7.0, 10.5)
RBK RBK 410 9783 152 11 35 212 1.3 (1.1, 1.5) 4.0 (3.6, 4.4) 5.6 (5.0, 6.2)
Rocc Rocc* 37 575 12 1 2 22 1.7 (0.9, 3.2) 5.2 (3.6, 7.3) 6.9 (5.0, 9.4)
Rotaglide Plus Rotaglide Plus* 70 616 30 1 5 34 0.8 (0.3, 2.0) 5.8 (4.1, 8.0) 11.0 (8.7, 14.0)
Scorpio CR Scorpio+* 162 2448 36 10 24 92 0.9 (0.6, 1.4) 4.2 (3.5, 5.1) 6.7 (5.7, 7.8)
Scorpio CR Series 7000 502 11261 121 26 42 313 0.9 (0.7, 1.1) 3.4 (3.0, 3.8) 5.2 (4.8, 5.8)
Scorpio PS Scorpio 31 524 8 . 9 14 1.2 (0.5, 2.6) 4.5 (3.0, 6.7) 6.2 (4.3, 8.7)
Scorpio PS Scorpio+* 133 2036 34 12 9 78 1.4 (1.0, 2.1) 5.0 (4.1, 6.0) 6.5 (5.5, 7.7)
Scorpio PS Series 7000 304 4679 102 8 60 134 1.3 (1.0, 1.7) 4.7 (4.1, 5.4) 6.9 (6.1, 7.8)
Triathlon CR Triathlon 1174 59826 181 55 67 871 0.8 (0.8, 0.9) 2.5 (2.3, 2.6) 3.7 (3.3, 4.0)
Triathlon PS Triathlon 323 9547 51 20 39 213 1.5 (1.3, 1.8) 4.0 (3.6, 4.5) 5.0 (4.3, 5.8)
Vanguard CR Maxim 394 15727 81 18 34 261 0.8 (0.7, 1.0) 3.3 (3.0, 3.7) 4.8 (4.2, 5.7)
Vanguard PS Maxim 210 4251 48 7 44 111 1.8 (1.4, 2.2) 5.5 (4.8, 6.4) 7.3 (6.0, 8.8)
TOTAL 17160 453197 4506 849 1704 10101
* denotes prosthesis combinations with no reported use in primary total knee procedures in 2016

a o a .o rg.au 49
FIFTEEN YEAR OUTCOMES KNEE REPLACEMENT

This year, the Registry is reporting 15 year The listed prosthesis combinations were used in
outcomes for 36 hip prosthesis and 24 knee 39.2% of all primary total knee replacement
prosthesis combinations. A combination is procedures for osteoarthritis. Of the 24
included if more than 350 procedures have combinations, nine had no reported use in
been reported to the Registry and the follow up 2016.
period is 15 or more years.
from 4.4% to 11.5%. Eight of the combinations
HIP REPLACEMENT
have a cumulative percent revision of less than
The listed prosthesis combinations were used in 6.5% and one with less than 5% at 15 years.
35.8% of all primary total conventional hip These are indicated in bold text in Table FY2.
replacement procedures for osteoarthritis. Of
the 36 combinations, 17 had no reported use in
2016.
from 3.2% to 17.0%. There are 13 combinations
which have a cumulative percent revision of
less than 6.5% and six with less than 5%. These
are indicated in bold text in Table FY1.
Table FY1 Cumulative Percent Revision of Primary Total Conventional Hip Replacement Combinations with 15 Year Data
Type of Revision
THR Femoral Acetabular Other 5 Yrs 10 Yrs 15 Yrs
ABGII ABGII 237 2755 31 116 60 30 4.1 (3.4, 4.9) 6.9 (6.0, 8.0) 11.6 (10.1, 13.2)
Alloclassic Allofit 215 4914 24 83 43 65 2.8 (2.3, 3.3) 4.9 (4.2, 5.6) 8.3 (6.7, 10.2)
Alloclassic Fitmore 118 1709 12 60 12 34 5.8 (4.7, 7.0) 7.7 (6.4, 9.2) 10.1 (7.3, 13.9)
C-Stem Duraloc* 70 894 9 17 11 33 3.8 (2.7, 5.3) 7.0 (5.4, 9.0) 12.4 (9.3, 16.3)
CLS Fitmore 46 712 5 21 7 13 4.8 (3.4, 6.8) 6.2 (4.5, 8.5) 10.2 (7.4, 14.1)
CPT Trilogy 246 6962 22 74 33 117 3.2 (2.8, 3.7) 4.8 (4.1, 5.5) 5.9 (5.0, 6.9)
CPT ZCA 29 780 10 5 8 6 2.4 (1.4, 3.8) 4.7 (3.1, 7.2) 7.3 (4.6, 11.3)
Charnley Charnley Ogee* 54 630 31 7 4 12 4.9 (3.5, 7.0) 8.1 (6.1, 10.8) 13.4 (9.8, 18.2)
Charnley Charnley* 39 563 30 6 3 . 2.2 (1.3, 3.9) 6.5 (4.5, 9.4) 11.6 (8.3, 16.2)
Charnley Vitalock* 35 370 5 17 2 11 4.4 (2.7, 7.1) 7.9 (5.5, 11.4) 11.7 (8.4, 16.1)
Citation Trident (Shell)* 42 1035 3 9 11 19 3.2 (2.3, 4.5) 3.9 (2.9, 5.3) 4.9 (3.5, 6.8)
Citation Vitalock* 34 508 2 5 11 16 2.0 (1.1, 3.7) 5.0 (3.3, 7.4) 10.0 (7.0, 14.2)
Elite Plus Duraloc* 97 953 14 57 6 20 5.1 (3.9, 6.8) 8.8 (7.0, 10.9) 14.8 (11.9, 18.3)
Exeter Contemporary* 35 427 8 6 13 8 4.2 (2.6, 6.6) 6.0 (4.0, 8.9) 12.1 (8.6, 16.8)
Exeter Vitalock* 58 1076 7 10 23 18 2.3 (1.5, 3.4) 4.6 (3.4, 6.1) 6.6 (5.1, 8.5)
Exeter V40 ABGII 34 973 8 12 8 6 1.6 (1.0, 2.7) 3.4 (2.3, 4.8) 4.7 (3.3, 6.6)
Exeter V40 Contemporary 215 4398 48 38 98 31 3.3 (2.8, 3.9) 5.8 (5.0, 6.7) 8.4 (7.1, 9.9)
Exeter V40 Exeter* 73 1526 12 14 30 17 2.9 (2.1, 3.9) 4.5 (3.5, 5.8) 8.1 (6.1, 10.7)
Exeter V40 Trident (Shell) 1083 45826 143 319 161 460 2.3 (2.1, 2.4) 3.7 (3.5, 4.0) 5.0 (4.4, 5.6)
Exeter V40 Vitalock* 66 1795 14 19 19 14 2.3 (1.7, 3.1) 3.2 (2.5, 4.2) 4.6 (3.6, 5.9)
F2L SPH-Blind* 53 571 6 19 15 13 6.1 (4.4, 8.4) 7.6 (5.7, 10.2) 11.7 (8.7, 15.7)
MS 30 Fitmore 19 572 1 4 7 7 1.5 (0.7, 3.2) 2.8 (1.5, 5.1) 6.5 (3.9, 10.9)
MS 30 Low Profile Cup 14 594 5 2 6 1 1.0 (0.4, 2.3) 2.4 (1.3, 4.4) 3.2 (1.8, 5.8)
Mallory-Head Mallory-Head 156 2863 13 13 50 80 3.0 (2.4, 3.7) 4.9 (4.1, 5.9) 10.3 (8.5, 12.5)
Meridian Vitalock* 29 354 2 2 12 13 3.5 (2.0, 6.1) 6.4 (4.2, 9.6) 9.9 (6.9, 14.1)
Natural Hip Fitmore* 35 882 2 5 11 17 2.0 (1.3, 3.2) 4.1 (2.9, 5.9) 4.9 (3.5, 6.9)

Type of Revision
THR Femoral Acetabular Other 5 Yrs 10 Yrs 15 Yrs
Omnifit Secur-Fit* 77 716 7 21 17 32 6.2 (4.6, 8.2) 9.9 (7.9, 12.5) 13.2 (10.6, 16.5)
Omnifit Trident (Shell) 134 3613 12 31 22 69 3.1 (2.5, 3.7) 3.9 (3.3, 4.7) 5.8 (4.7, 7.3)
S-Rom Duraloc Option* 25 523 4 9 5 7 3.3 (2.1, 5.2) 4.6 (3.1, 6.8) 5.2 (3.5, 7.8)
Secur-Fit Trident (Shell) 303 8524 22 128 56 97 3.3 (2.9, 3.7) 4.4 (3.9, 5.0) 5.5 (4.6, 6.6)
Secur-Fit Plus Trident (Shell) 155 5333 12 40 35 68 2.2 (1.8, 2.6) 3.1 (2.6, 3.7) 4.4 (3.5, 5.4)
Spectron EF Reflection (Cup) 104 1398 36 10 49 9 2.8 (2.1, 3.9) 7.2 (5.7, 9.0) 17.0 (13.4, 21.5)
Spectron EF Reflection (Shell) 243 4584 52 79 37 75 2.7 (2.2, 3.2) 5.5 (4.7, 6.3) 10.7 (9.1, 12.7)
Stability Duraloc* 44 374 1 9 13 21 2.2 (1.1, 4.3) 8.9 (6.3, 12.5) 14.6 (10.9, 19.6)
Synergy Reflection (Shell) 299 7314 26 61 99 113 2.6 (2.3, 3.0) 3.9 (3.4, 4.4) 6.4 (5.4, 7.5)
VerSys Trilogy 203 4363 13 71 36 83 3.7 (3.2, 4.4) 4.9 (4.2, 5.6) 5.4 (4.7, 6.2)
TOTAL 4719 121384 652 1399 1033 1635
* denotes prosthesis combinations with no reported use in primary total conventional hip procedures in 2016
Table FY2 Cumulative Percent Revision of Primary Total Knee Replacement Combinations with 15 Year Data (Primary
Diagnosis OA)
Type of Revision
Femoral Tibial N N
TKR Femoral Tibial Other 5 Yrs 10 Yrs 15 Yrs
AGC AGC 245 5026 90 5 25 125 3.1 (2.7, 3.7) 4.9 (4.3, 5.7) 7.4 (6.4, 8.6)
Advance Advance II 96 1596 32 2 13 49 4.9 (3.9, 6.1) 6.9 (5.7, 8.5) 7.8 (6.2, 9.7)
Advantim Advantim* 61 1454 28 3 3 27 3.1 (2.3, 4.1) 4.7 (3.6, 6.2) 6.4 (4.7, 8.8)
Duracon Duracon* 1044 19830 251 29 67 697 3.4 (3.2, 3.7) 5.0 (4.7, 5.3) 7.1 (6.6, 7.6)
Genesis II CR Genesis II 760 20944 144 49 49 518 3.4 (3.2, 3.7) 4.7 (4.3, 5.0) 5.8 (5.2, 6.4)
Genesis II CR Profix Mobile* 100 1209 38 9 7 46 5.4 (4.2, 6.9) 7.9 (6.4, 9.7) 11.2 (9.1, 13.8)
Genesis II Oxinium CR (ct Genesis II 354 7468 60 23 22 249 3.7 (3.3, 4.2) 6.2 (5.6, 7.0) 11.0 (8.5, 14.3)
Genesis II PS Genesis II 631 16463 96 26 45 464 3.8 (3.5, 4.1) 5.3 (4.8, 5.8) 6.6 (5.7, 7.7)
Kinemax Plus Kinemax Plus* 112 1815 64 3 5 40 3.2 (2.4, 4.1) 4.7 (3.8, 5.8) 8.5 (7.0, 10.4)
LCS CR LCS 554 8301 221 23 84 226 4.4 (4.0, 4.9) 6.2 (5.7, 6.8) 7.8 (7.2, 8.5)
LCS CR MBT 879 25962 282 41 118 438 3.5 (3.3, 3.8) 5.0 (4.6, 5.3) 6.1 (5.4, 6.8)
LCS CR MBT Duofix 605 13412 164 26 38 377 4.1 (3.8, 4.5) 5.4 (5.0, 5.9) 7.2 (6.3, 8.2)
MBK (Zimmer) Nexgen* 30 448 16 1 1 12 4.1 (2.6, 6.5) 5.9 (4.0, 8.6) 8.0 (5.5, 11.5)
Maxim Maxim* 172 2447 53 15 12 92 4.0 (3.3, 4.8) 6.0 (5.1, 7.1) 11.1 (8.9, 13.9)
Natural Knee II Natural Knee II* 357 6443 144 8 58 147 2.8 (2.4, 3.2) 5.3 (4.7, 6.0) 10.6 (9.1, 12.2)
Nexgen CR Nexgen 332 10977 103 14 31 184 2.1 (1.8, 2.3) 3.1 (2.7, 3.4) 4.4 (3.9, 5.0)
Nexgen LPS Nexgen 289 6591 69 19 32 169 3.2 (2.8, 3.7) 5.1 (4.5, 5.7) 6.3 (5.5, 7.3)
PFC Sigma CR MBT 257 5742 38 30 42 147 4.1 (3.6, 4.7) 5.2 (4.6, 5.9) 6.1 (5.2, 7.2)
PFC Sigma CR PFC Sigma 599 22644 124 45 53 377 2.4 (2.2, 2.6) 3.5 (3.2, 3.8) 5.1 (4.5, 5.9)
PFC Sigma PS PFC Sigma 263 7317 82 8 22 151 3.2 (2.8, 3.7) 4.7 (4.1, 5.4) 7.3 (5.9, 8.9)
Profix Profix* 259 5370 55 13 18 173 3.7 (3.2, 4.3) 5.1 (4.6, 5.8) 5.5 (4.8, 6.2)
Scorpio CR Series 7000 502 11261 121 26 42 313 3.4 (3.0, 3.8) 5.2 (4.8, 5.8) 6.7 (6.1, 7.4)
Scorpio PS Scorpio+* 133 2036 34 12 9 78 5.0 (4.1, 6.0) 6.5 (5.5, 7.7) 8.5 (6.9, 10.5)
Scorpio PS Series 7000 304 4679 102 8 60 134 4.7 (4.1, 5.4) 6.9 (6.1, 7.8) 11.5 (9.4, 14.1)
TOTAL 8938 209435 2411 438 856 5233
* denotes prosthesis combinations with no reported use in primary total knee procedures in 2016

a o a .o rg.au 51
Hip Replacement
Hip Replacement
CATEGORIES OF HIP REPLACEMENT
The Registry groups hip replacement into three each of these are detailed in the subsequent
broad categories: primary partial, primary total sections.
and revision hip replacement.
Revision hip replacements are re-operations of
A primary replacement is an initial replacement previous hip replacements where one or more
procedure undertaken on a joint and involves of the prosthetic components are replaced,
replacing either part (partial) or all (total) of the removed, or one or more components are
articular surface. added. Revisions include re-operations of
primary partial, primary total, or previous
Primary partial and primary total hip revision procedures. Hip revisions are sub-
replacement are further sub-categorised into categorised into three classes: major total,
classes depending on the type of prostheses major partial, or minor revisions.
used. Partial hip classes are: partial resurfacing,
Detailed information on demographics of each category of hip
unipolar monoblock, unipolar modular, and replacement is available in the supplementary report ‘Demographics of
bipolar. Total hip classes are: resurfacing, Hip, Knee and Shoulder Arthroplasty’ on the AOANJRR website
conventional, and thrust plate. Definitions for https://aoanjrr.sahmri.com/annual-reports-2017
HIP REPLACEMENT
PARTIAL TOTAL REVISION
PARTIAL
RESURFACING
TOTAL MAJOR
RESURFACING TOTAL
UNIPOLAR
MONOBLOCK
TOTAL MAJOR
CONVENTIONAL PARTIAL
UNIPOLAR
MODULAR
THRUST
MINOR
PLATE
BIPOLAR

a o a .o rg.au 53
USE OF HIP REPLACEMENT

This report analyses 545,831 hip replacements The number of hip replacements undertaken in
reported to the Registry with a procedure date 2016 increased by 1,639 (3.7%) compared to
up to and including 31 December 2016. This is 2015. During this time, the use of primary total
an additional 47,171 hip procedures compared hip replacement increased by 5.6% accounting
to the number reported last year. When for 78.4% of all hip replacement procedures in
considering all hip procedures currently 2016. Primary partial hip replacement
recorded by the Registry, primary partial hip decreased by 1.5% accounting for 12.7% of hip
accounts for 15.3%, primary total hip 73.3% and procedures in 2016.
revision hip replacement 11.4% (Table H1).
The proportion of revision hip procedures has
declined from a peak of 12.9% in 2003 to 8.9% in
Table H1 Number of Hip Replacements 2016. This equates to 1,871 fewer revision
procedures in 2016 than would have been
Hip Category Number Percent expected if the proportion of revision
Partial 83389 15.3 procedures had remained at 12.9% (Figure H1).
Total 400331 73.3
Revision 62111 11.4
TOTAL 545831 100.0 Figure H1 Proportion of Hip Replacement
100%
Partial
90% Total
The number of hip replacement procedures Revision
undertaken in 2016 is 73.7% higher than the 80%
number undertaken in 2003. The corresponding 70%

increase in primary total hip replacement is 60%
94.4%, primary partial 30.1%, and revision hip
50%
replacement 19.4%.
40%
30%
20%
10%
0%
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20

ASA SCORE AND BMI IN HIP REPLACEMENT

Data is reported on hip replacement Overall, in 85.7% of procedures, patients have
procedures for both the American Society of an ASA score of 2 or 3, 8.7% have a score of 1,
Anaesthesiologists - Physical Status Classification and 5.6% have a score of 4. Very few
(ASA score) and Body Mass Index (BMI). The procedures were recorded where patients
Registry commenced collecting ASA score in have a score of 5.
2012 and BMI in 2015.
There is a difference in ASA score depending
There is ASA score data on 158,657 hip on the class of hip replacement. Partial hip
replacement procedures and BMI data on replacement procedures have a higher
72,892 hip replacement procedures. proportion of patients with ASA scores 3 and 4
(85.8%), compared to those undergoing
In 2016, the ASA score is reported in 99.4% of hip primary total hip replacement (35.1%). Revision
replacement procedures and BMI in 84.2% of hip replacement procedures also have patients
hip replacement procedures. with higher ASA scores compared to those
having a primary total hip replacement, but not
There is no variation in reporting of ASA based as high as those having a partial hip
on procedure type. However, there is some replacement (57.4% have an ASA score of 3 or
variation in the reporting of BMI. The Registry 4) (Table H2).
has BMI recorded for 47.5% of primary partial
BMI
hip, 90.6% of primary total hip, and 80.6% of
revision hip replacement procedures. BMI for adults is classified by the World Health
Organisation into six main categories
ASA score and BMI are both known to impact (http://apps.who.int/bmi/index.jsp?introPage=i
the outcome of hip replacement surgery. In the ntro_3.html):
future, this data will be used to risk adjust in a 1. Underweight <18.50
range of analyses. 2. Normal 18.50 - 24.99
3. Pre-obese 25.00 - 29.99
ASA SCORE
4. Obese Class 1 30.00 - 34.99
There are five ASA score classifications 5. Obese Class 2 35.00 - 39.99
(https://www.asahq.org/resources/clinical- 6. Obese Class 3 ≥40.00
information/asa-physical-status-classification-
system): For all hip replacement, the majority of
1. A normal healthy patient procedures are undertaken in patients who are
2. A patient with mild systemic disease normal or pre-obese (60.8%). There is a similar
3. A patient with severe systemic disease proportion of primary total and revision hip
4. A patient with severe systemic disease replacement procedures where the patients
that is a constant threat to life are normal or pre-obese in 59.5% of primary
5. A moribund patient who is not total hip procedures and in 60.4% of revision hip
expected to survive without the replacement procedures.
operation
In partial hip replacement procedures, patients
generally have a lower BMI, with most being
normal or underweight (59.6%) (Table H3).
There is a gender difference with a higher

proportion of males in the normal and pre-
obese categories, which is most apparent in
primary total and revision hip replacement
procedures (Figure H2).

a o a .o rg.au 55
Table H2 ASA Score by Hip Category
Partial Total Revision TOTAL

ASA Score N Col% N Col% N Col% N Col%
1 90 0.4 12957 10.6 774 5.0 13821 8.7
2 2829 13.5 66304 54.3 5850 37.6 74983 47.3
3 12754 60.8 40471 33.1 7715 49.7 60940 38.4
4 5219 24.9 2399 2.0 1190 7.7 8808 5.6
5 84 0.4 12 0.0 9 0.1 105 0.1
TOTAL 20976 100.0 122143 100.0 15538 100.0 158657 100.0
Table H3 BMI Category for Hip Replacement by Hip Category

BMI Category N Col% N Col% N Col% N Col%
Underweight 501 9.6 659 1.1 118 1.8 1278 1.8
Normal 2619 50.0 13728 22.5 1669 25.5 18016 24.7
Pre-obese 1434 27.4 22609 37.0 2280 34.9 26323 36.1
Obese Class 1 488 9.3 14849 24.3 1496 22.9 16833 23.1
Obese Class 2 148 2.8 6189 10.1 647 9.9 6984 9.6
Obese Class 3 45 0.9 3089 5.1 324 5.0 3458 4.7
TOTAL 5235 100.0 61123 100.0 6534 100.0 72892 100.0
Note: BMI has not been presented for patients aged 19 and under
Figure H2 BMI Distribution by Gender and Hip Category

Primary Partial Hip Replacement

CLASSES OF PARTIAL HIP REPLACEMENT Figure HP1 Primary Partial Hip Replacement by Class
5000
The Registry identifies four classes of primary Partial Resurfacing Unipolar Monoblock
Unipolar Modular Bipolar
partial hip replacement. These are defined by
the type of prostheses used. 4000
Partial resurfacing involves the use of one or

3000
more button prostheses to replace part of the
natural articulating surface on one or both sides
of the hip joint. 2000
Unipolar monoblock involves the use of a
femoral stem prosthesis with a fixed large head 1000
that replaces the natural femoral head.
Unipolar modular involves the use of a femoral
stem and exchangeable large head prosthesis 0
03
04
05
06
07
08
09
10
11
12
13
14
15
16
that replaces the natural femoral head.
20
20
20
20
20
20
20
20
20
20
20
20
20
20
Bipolar involves the use of a femoral stem and
standard head prosthesis that articulates with a
non-fixed component replacing the natural
Detailed information on Partial Resurfacing Hip Replacement is available in
femoral head.
the supplementary report ‘Outcomes of Classes No Longer Used Hip and
Knee Arthroplasty’ on the AOANJRR website
There is a fifth class of partial hip replacement https://aoanjrr.sahmri.com/annual-reports-2017.
that has been reported to the Registry. It
involves the use of a prosthesis referred to by Fractured neck of femur is the principal
the manufacturer as an ‘acetabular buffer’. diagnosis for the three main classes of primary
This is a polycarbonate urethane insert. Five partial hip replacement: unipolar monoblock
procedures using this device have been (97.6%), unipolar modular (95.0%) and bipolar
reported to the Registry, four of which have (91.3%). A comparative analysis of partial hip
been revised. replacement with total conventional hip
replacement was undertaken for fractured
USE OF PARTIAL HIP REPLACEMENT neck of femur and is presented in the primary
total hip replacement chapter.
The most common class of primary partial hip
replacement is unipolar modular. This accounts
for 43.3% of all partial hip procedures, followed At 10 years, bipolar hip replacement has the
by unipolar monoblock (33.7%) and bipolar lowest cumulative percent revision, followed
(23.0%) (Table HP1). by unipolar modular and unipolar
monoblock.
Table HP1 Primary Partial Hip Replacement by Class
Partial Hip Class Number Percent

Unipolar Monoblock 28122 33.7
The outcome of primary partial hip
replacement varies depending on the class.
Unipolar Modular 36090 43.3
Outcomes are restricted to 10 years because of
Bipolar 19163 23.0
the high mortality in this group. The prosthesis
TOTAL 83375 100.0 class variation in mortality is almost certainly
Note: Excludes 14 partial resurfacing procedures.
due to patient selection (Table HP2). At 10
years, bipolar has the lowest cumulative
There is a slight increase in the use of bipolar
percent revision, followed by unipolar modular
and unipolar modular partial hip replacements
and unipolar monoblock (Table HP3 and Figure
in 2016. The use of unipolar monoblock
HP2). The difference in outcome between
continues to decline (Figure HP1).
classes is most apparent in patients aged less
Detailed demographic information on primary partial hip replacement is than 75 years (Table HP4 and Figure HP3).
available in the supplementary report ‘Demographics of Hip, Knee and
Shoulder Arthroplasty’ on the AOANJRR website
https://aoanjrr.sahmri.com/annual-reports-2017.

a o a .o rg.au 57
Table HP2 Cumulative Percent Mortality of Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF)
N N
Hip Class 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Deceased Total
Unipolar Monoblock 22668 26769 36.5 (36.0, 37.1) 49.6 (48.9, 50.2) 60.3 (59.7, 60.9) 76.2 (75.6, 76.7) 85.4 (84.9, 85.9) 92.8 (92.4, 93.2)
Unipolar Modular 19082 33253 23.9 (23.4, 24.3) 34.2 (33.7, 34.8) 43.6 (43.1, 44.2) 59.4 (58.8, 60.1) 70.8 (70.2, 71.5) 81.4 (80.7, 82.1)
Bipolar 10011 17060 21.0 (20.4, 21.7) 30.6 (29.9, 31.4) 38.9 (38.1, 39.7) 53.4 (52.5, 54.2) 64.9 (64.0, 65.8) 77.0 (76.1, 77.8)
TOTAL 51761 77082
Table HP3 Cumulative Percent Revision of Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF)
N N
Revised Total
Bipolar 606 17486 2.3 (2.0, 2.5) 3.1 (2.8, 3.4) 3.7 (3.4, 4.0) 4.4 (4.0, 4.8) 5.0 (4.6, 5.5) 6.4 (5.7, 7.0)
TOTAL 2789 79225
Figure HP2 Cumulative Percent Revision of Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF)

20%
Unipolar Monoblock
Unipolar Monoblock vs Unipolar Modular
Unipolar Modular
Bipolar
16% Bipolar vs Unipolar Modular

0 - 3Mth: HR=1.12 (0.96, 1.30),p=0.136
14%
3Mth+: HR=0.79 (0.70, 0.89),p<0.001
12%
Unipolar Monoblock vs Bipolar
0 - 2Wk: HR=1.80 (1.34, 2.41),p<0.001
10%
2Wk - 3Mth: HR=1.09 (0.91, 1.30),p=0.367
8% 3Mth+: HR=1.73 (1.52, 1.97),p<0.001
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Unipolar Monoblock 27453 16627 12742 9621 5235 2828 1045
Unipolar Modular 34286 23221 17936 13572 7314 3598 1015
Bipolar 17486 12050 9300 7415 4866 3191 1598

Table HP4 Cumulative Percent Revision of Primary Partial Hip Replacement in Patients Aged <75 Years by Class (Primary
N N
Revised Total
Bipolar 213 3528 2.8 (2.3, 3.4) 4.4 (3.7, 5.2) 5.4 (4.6, 6.3) 6.4 (5.5, 7.4) 7.8 (6.7, 9.0) 9.2 (8.0, 10.6)
TOTAL 859 11534
Figure HP3 Cumulative Percent Revision of Primary Partial Hip Replacement in Patients Aged <75 Years by Class (Primary

20%
Unipolar Monoblock
Unipolar Monoblock vs Bipolar
Unipolar Modular
Bipolar
16% Unipolar Modular vs Bipolar

0 - 2.5Yr: HR=1.11 (0.91, 1.35),p=0.298
14%
2.5Yr+: HR=2.21 (1.73, 2.81),p<0.001
12%
Unipolar Monoblock vs Unipolar Modular
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Bipolar 3528 2701 2211 1919 1479 1150 719

a o a .o rg.au 59
UNIPOLAR MONOBLOCK
DEMOGRAPHICS
The Registry has recorded 28,122 unipolar The majority of patients are female (73.1%) and
monoblock procedures. This is an additional 590 aged 75 years or older (91.3%). The proportion
procedures compared to the previous report. of patients aged 85 years or older has
increased from 51.0% in 2003 to 64.3% in 2016.
The use of monoblock hip replacement in The mean age of patients is 84.5 years (Table
Australia continues to decline. The number of HP5, Figures HP4 and HP5).
procedures reported in 2016 has declined by
26.4% compared to 2015 and by 79.0% Figure HP5 Primary Unipolar Monoblock Hip Replacement
compared to 2003. by Age
100%
Fractured neck of femur is the principal <55 55-64
90% 65-74 75-84
diagnosis for primary unipolar monoblock hip ≥85
replacement (97.6%). 80%
70%
Figure HP4 Primary Unipolar Monoblock Hip Replacement 60%
by Gender
50%
100%
Male 40%
90% Female
30%
80%
20%
70%
10%
60% 0%
50%
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
40%
30%
The three types of unipolar monoblock
20%
prostheses are: the Austin-Moore Type,
10% Thompson Type, and Exeter Trauma Stem (ETS).
0% In 2016, the use of the Austin-Moore Type
decreased by 42.5% compared to 2015, and by
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
91.1% compared to 2003. The Thompson Type

decreased by 48.2% compared to 2015, and by
80.8% compared to 2003. In 2016, the use of the
ETS increased by 16.2% compared to 2015, and
accounted for 47.4% of all monoblock
prostheses (Table HP6).
Table HP5 Age and Gender of Primary Unipolar Monoblock Hip Replacement
Gender Number Percent Minimum Maximum Median Mean Std Dev

Male 7558 26.9% 32 107 84 83.4 7.8
Female 20564 73.1% 16 108 86 84.9 7.1
TOTAL 28122 100.0% 16 108 85 84.5 7.3
Table HP6 Most Used Monoblock Prostheses in Primary Unipolar Monoblock Hip Replacement
2003 2013 2014 2015 2016

N Model N Model N Model N Model N Model
1988 Austin-Moore Type 616 Austin-Moore Type 512 Austin-Moore Type 308 Austin-Moore Type 251 ETS
526 Thompson Type 322 Thompson Type 283 ETS 216 ETS 177 Austin-Moore Type
252 ETS 268 Thompson Type 195 Thompson Type 101 Thompson Type
Most Used
2514 (2) 100.0% 1190 (3) 100.0% 1063 (3) 100.0% 719 (3) 100.0% 529 (3) 100.0%

OUTCOME FOR FRACTURED NECK OF FEMUR

The cumulative percent revision at 10 years for There is no difference in the outcome between
unipolar monoblock replacement undertaken males and females (Table HP11 and Figure
for fractured neck of femur is 7.6% (Table HP7 HP8).
and Figure HP6).
In the first 1.5 years, cementless fixation has a
The main reason for revision is loosening (43.5%), higher rate of revision compared to cemented
followed by fracture (19.7%), and prosthesis fixation, with no difference after this time (Table
dislocation (11.3%) (Table HP8). The majority of HP12 and Figure HP9).
unipolar monoblock hip replacements are
revised to a total hip replacement (60.3%). The Thompson Type prosthesis, though
Revision to another unipolar hip replacement designed to be cemented, has been inserted
(femoral component only) has occurred in without cement in 574 procedures. This has the
18.4% of revisions (Table HP9). highest rate of revision.
Age and femoral stem fixation are risk factors The Thompson Type cemented and Austin
for revision. The rate of revision decreases with Moore Type cementless have a higher rate of
increasing age (Table HP10 and Figure HP7). revision compared to the ETS, but there is no
difference for the Austin Moore Type when it is
used with cement (Figure HP10).
Table HP7 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement (Primary Diagnosis Fractured NOF)
N N
Revised Total
TOTAL 1034 27453
Figure HP6 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement (Primary Diagnosis Fractured NOF)
20%
Unipolar Monoblock
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16


a o a .o rg.au 61
Table HP8 Primary Unipolar Monoblock Hip Replacement Table HP9 Primary Unipolar Monoblock Hip Replacement
by Reason for Revision (Primary Diagnosis by Type of Revision (Primary Diagnosis
Fractured NOF) Fractured NOF)
Reason for Revision Number Percent Type of Revision Number Percent

Loosening 450 43.5 THR (Femoral/Acetabular) 623 60.3
Fracture 204 19.7 Femoral Component 190 18.4
Prosthesis Dislocation 117 11.3 Bipolar Head and Femoral 98 9.5
Infection 109 10.5 Removal of Prostheses 54 5.2
Pain 76 7.4 Cement Spacer 43 4.2
Chondrolysis/Acetab. Erosion 44 4.3 Minor Components 17 1.6
Malposition 12 1.2 Reinsertion of Components 6 0.6
Lysis 9 0.9 Incomplete 1 0.1
Other 13 1.3 Bipolar Only 1 0.1
TOTAL 1034 100.0 Insert Only 1 0.1
TOTAL 1034 100.0
Note: Femoral heads are usually replaced when the acetabular

component and/or femoral stem is revised.
Table HP10 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement by Age (Primary Diagnosis
Fractured NOF)
N N
Age 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
<75 218 2377 4.4 (3.6, 5.4) 7.2 (6.1, 8.5) 9.6 (8.3, 11.2) 12.8 (11.2, 14.7) 14.7 (12.8, 16.8) 15.8 (13.7, 18.2)
75-84 467 10291 3.3 (2.9, 3.7) 4.6 (4.2, 5.1) 5.5 (5.0, 6.0) 6.4 (5.8, 7.1) 7.1 (6.5, 7.9) 8.4 (7.4, 9.5)
≥85 349 14785 2.4 (2.1, 2.7) 2.9 (2.6, 3.2) 3.1 (2.8, 3.5) 3.6 (3.2, 4.1) 3.8 (3.3, 4.3) 4.4 (3.6, 5.4)
TOTAL 1034 27453
Figure HP7 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement by Age (Primary Diagnosis
Fractured NOF)
HR - adjusted for gender

20%
<75
<75 vs ≥85
75-84
18% 0 - 3Mth: HR=1.20 (0.85, 1.69),p=0.307
≥85
3Mth - 1Yr: HR=3.08 (2.19, 4.31),p<0.001
16%
1Yr - 2Yr: HR=5.34 (3.71, 7.70),p<0.001
14% 2Yr+: HR=6.84 (5.05, 9.26),p<0.001

12% 75-84 vs ≥85

0 - 3Mth: HR=1.01 (0.81, 1.25),p=0.957
10% 3Mth+: HR=2.34 (1.93, 2.82),p<0.001
8% <75 vs 75-84
0 - 1Yr: HR=1.26 (0.99, 1.60),p=0.059
6%
1Yr - 1.5Yr: HR=2.63 (1.69, 4.08),p<0.001
1.5Yr+: HR=2.66 (2.08, 3.41),p<0.001
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

<75 2377 1613 1315 1071 723 497 237
75-84 10291 6682 5306 4162 2497 1417 542
≥85 14785 8332 6121 4388 2015 914 266

Table HP11 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement by Gender (Primary Diagnosis
Fractured NOF)
N N
Gender 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
Male 268 7378 3.6 (3.1, 4.2) 4.9 (4.3, 5.7) 6.1 (5.4, 7.0) 7.2 (6.3, 8.3) 8.0 (6.9, 9.3) 8.7 (7.3, 10.3)
Female 766 20075 2.7 (2.5, 3.0) 3.8 (3.5, 4.1) 4.4 (4.1, 4.8) 5.4 (5.0, 5.9) 6.2 (5.7, 6.7) 7.3 (6.6, 8.1)
TOTAL 1034 27453
Figure HP8 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement by Gender (Primary Diagnosis
Fractured NOF)
HR - adjusted for age

20%
Male
Male vs Female
Female
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Male 7378 3482 2372 1651 795 415 155
Female 20075 13145 10370 7970 4440 2413 890

a o a .o rg.au 63
Table HP12 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement by Femoral Fixation and Prosthesis
Type (Primary Diagnosis Fractured NOF)
Femoral Unipolar N N
1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Fixation Monoblock Revised Total
Cementless 776 17454 3.8 (3.5, 4.1) 5.1 (4.7, 5.5) 5.8 (5.4, 6.3) 6.6 (6.1, 7.1) 7.4 (6.8, 8.0) 8.3 (7.5, 9.1)
Austin-Moore 728 16880 3.7 (3.4, 4.0) 5.0 (4.6, 5.4) 5.7 (5.3, 6.2) 6.4 (5.9, 6.9) 7.2 (6.6, 7.8) 8.0 (7.3, 8.8)
Thompson 48 574 6.6 (4.7, 9.3) 7.5 (5.4, 10.5) 9.4 (6.9, 12.8) 12.3 (9.0, 16.6) 13.0 (9.5, 17.6)
Cemented 258 9999 1.5 (1.3, 1.8) 2.2 (1.9, 2.6) 2.9 (2.5, 3.4) 4.4 (3.9, 5.1) 5.1 (4.4, 5.9) 6.7 (5.4, 8.2)
Austin-Moore 18 935 1.4 (0.7, 2.6) 2.1 (1.2, 3.6) 3.0 (1.8, 5.0) 4.0 (2.4, 6.8) 4.0 (2.4, 6.8)
ETS 62 2960 1.4 (1.0, 2.0) 1.9 (1.4, 2.5) 2.4 (1.8, 3.2) 3.3 (2.5, 4.4) 4.4 (3.2, 6.2)
Thompson 178 6104 1.6 (1.3, 2.0) 2.4 (2.0, 2.9) 3.1 (2.6, 3.7) 5.0 (4.2, 5.9) 5.5 (4.6, 6.5) 7.5 (5.9, 9.5)
TOTAL 1034 27453
Figure HP9 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement by Femoral Fixation (Primary

20%
Cementless
Cementless vs Cemented
Cemented
18% 0 - 3Mth: HR=1.91 (1.50, 2.43),p<0.001
3Mth - 9Mth: HR=4.43 (2.89, 6.79),p<0.001

16%
9Mth - 1.5Yr: HR=2.49 (1.72, 3.60),p<0.001
14% 1.5Yr+: HR=0.99 (0.78, 1.25),p=0.904

12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Cementless 17454 10317 7863 5991 3312 1847 743
Cemented 9999 6310 4879 3630 1923 981 302

Figure HP10 Cumulative Percent Revision of Primary Unipolar Monoblock Hip Replacement by Prosthesis Type and Femoral
Fixation (Primary Diagnosis Fractured NOF)

20%
Austin-Moore Cementless
Austin-Moore Cementless vs ETS Cemented
Austin-Moore Cemented
ETS Cemented
Thompson Cementless
16% Austin-Moore Cemented vs ETS Cemented
Thompson Cemented
14%
Thompson Cementless vs ETS Cemented

12%
10%
Thompson Cemented vs ETS Cemented
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Austin-Moore Cementless 16880 9957 7581 5772 3192 1772 716
Cemented 935 505 382 282 126 58 16
ETS Cemented 2960 1837 1407 1043 541 257 38
Thompson Cementless 574 360 282 219 120 75 27
Cemented 6104 3968 3090 2305 1256 666 248

a o a .o rg.au 65
UNIPOLAR MODULAR
DEMOGRAPHICS
There have been 36,090 unipolar modular Figure HP12 Primary Unipolar Modular Hip Replacement
by Age
procedures reported to the Registry. This is an
additional 3,399 procedures compared to the 100%
<55 55-64
previous report. 65-74 75-84
90%
≥85
80%
In 2016, the number of unipolar modular
procedures increased by 0.8% compared to 70%
2015, and increased by 395.7% since 2003. 60%
50%
Fractured neck of femur is the principal
40%
diagnosis for primary unipolar modular hip
20%
10%
Figure HP11 Primary Unipolar Modular Hip Replacement
0%
by Gender
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
100%
Male
90% Female
80%
Overall, there have been 219 unipolar modular
70%
head and stem combinations. The 10 most
60%
frequently used unipolar modular head
50% prostheses and femoral stems are listed in
40% Tables HP14 and HP15.
30%
In 2016, 19 different unipolar modular head
20%
prostheses were used. The Unitrax head is the
10% most frequently used (61.8%). The 10 most used
0% unipolar modular head prostheses account for
99.1% of all primary unipolar modular hip
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
procedures.
There were 37 different stem prostheses used in

The majority of patients are female (71.4%) and 2016, eight less than in 2015. The most
aged 75 years or older (83.1%). The proportion frequently used stem in 2016 is the Exeter V40
of patients aged 85 years or older has (61.0%). The 10 most used femoral stems
increased from 32.0% in 2003 to 53.6% in 2016. account for 94.6% of all primary unipolar
The mean age of patients is 82.0 years (Table modular hip procedures.
HP13, Figures HP11 and HP12).
The cumulative percent revision of unipolar
modular head/steam prosthesis combinations
with more than 100 procedures is detailed in
Table HP16.
Table HP13 Age and Gender of Primary Unipolar Modular Hip Replacement

Male 10332 28.6% 19 106 83 80.9 9.5
Female 25758 71.4% 18 108 84 82.5 8.5
TOTAL 36090 100.0% 18 108 83 82.0 8.9

Table HP14 10 Most Used Unipolar Head Prostheses in Primary Unipolar Modular Hip Replacement
2003 2013 2014 2015 2016

193 Unitrax 1476 Unitrax 1612 Unitrax 1871 Unitrax 2041 Unitrax
Unipolar Head Unipolar Head
142 959 Unipolar Head (S&N) 958 Unipolar Head (S&N) 831 Unipolar Head (S&N) 645
(Zimmer) (S&N)
Unipolar Head
127 551 VerSys 523 VerSys 201 Cathcart 246 Cathcart
(S&N)
75 VerSys 127 Cathcart 162 Cathcart 167 VerSys 164 VerSys
Unipolar Head Unipolar Head Unipolar Head Unipolar Head
64 71 58 Pharo 61 63
(Mathys) (Corin) (Corin) (Corin)
46 Elite 52 Metasul 52 39 Unipolar Head (Lima) 49
(Corin) (Signature)
Unipolar Head
16 Ultima 28 38 Unipolar Head (JRI) 21 Unipolar Head (JRI) 25 Endo II
(Zimmer)
1 Metasul 27 Pharo 25 Unipolar Head (Lima) 19 FMP 16 Endo Head
Unipolar Head
1 Optimom 17 Unipolar Head (Lima) 15 18 Pharo 12 BioBall
(Zimmer)
1 8 FMP 14 FMP 14 9 Unipolar Head (Lima)
(Sulzer) (Mathys)
10 Most Used
666 (10) 100.0% 3316 (10) 99.2% 3457 (10) 99.5% 3242 (10) 99.0% 3270 (10) 99.1%
Remainder
0 (0) 0% 27 (7) 0.8% 18 (7) 0.5% 32 (11) 1.0% 31 (9) 0.9%
TOTAL
666 (10) 100.0% 3343 (17) 100.0% 3475 (17) 100.0% 3274 (21) 100.0% 3301 (19) 100.0%
Table HP15 10 Most Used Femoral Stem Prostheses in Primary Unipolar Modular Hip Replacement
2003 2013 2014 2015 2016

180 Exeter V40 1438 Exeter V40 1558 Exeter V40 1831 Exeter V40 2013 Exeter V40
111 Alloclassic 572 CPT 566 CPCS 528 CPCS 504 CPCS
91 CPT 518 CPCS 485 CPT 192 Spectron EF 137 C-Stem AMT
70 Spectron EF 181 SL-Plus 189 Spectron EF 149 CPT 133 CPT
49 Fullfix 178 Spectron EF 122 SL-Plus 107 C-Stem AMT 111 Corail
38 SL-Plus 83 Corail 88 C-Stem AMT 96 Corail 90 Spectron EF
33 Elite Plus 69 Metafix 74 Corail 67 SL-Plus 53 Metafix
18 Basis 55 Basis 57 Pharo 59 Metafix 30 Short Exeter V40
15 CCA 45 C-Stem AMT 52 Metafix 35 H-Max 26 E2
Thompson
15 42 Alloclassic 44 Omnifit 24 Absolut 25 Sirius
Modular Stem
10 Most Used
620 (10) 93.1% 3181 (10) 95.2% 3235 (10) 93.1% 3088 (10) 94.3% 3122 (10) 94.6%
Remainder
46 (13) 6.9% 162 (26) 4.8% 240 (35) 6.9% 186 (35) 5.7% 179 (27) 5.4%
TOTAL
666 (23) 100.0% 3343 (36) 100.0% 3475 (45) 100.0% 3274 (45) 100.0% 3301 (37) 100.0%

a o a .o rg.au 67
Table HP16 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement by Prosthesis Combination
Unipolar Femoral N N
Head Component Revised Total
Cathcart C-Stem AMT 6 426 1.5 (0.6, 3.5) 1.5 (0.6, 3.5) 1.5 (0.6, 3.5)
Cathcart Corail 78 1360 3.4 (2.5, 4.7) 4.8 (3.6, 6.2) 6.1 (4.7, 7.9) 7.9 (6.1, 10.0) 10.7 (8.3, 13.8)
Endo II Taperloc* 7 102 5.1 (2.2, 11.9) 5.1 (2.2, 11.9) 5.1 (2.2, 11.9)
Metasul Alloclassic* 16 345 2.5 (1.3, 4.9) 2.9 (1.5, 5.5) 3.7 (2.1, 6.7) 4.3 (2.4, 7.6) 8.8 (5.0, 15.2)
Metasul CPT* 4 215 1.6 (0.5, 4.9) 1.6 (0.5, 4.9) 2.4 (0.9, 6.6)
Pharo Pharo 6 141 3.1 (1.2, 8.1) 5.5 (2.4, 11.9)
U2 E2* 3 232 0.0 (0.0, 0.0) 0.7 (0.1, 4.9) 1.5 (0.4, 5.9) 2.6 (0.8, 8.2)
Thompson
Ultima 1 133 0.8 (0.1, 5.5) 0.8 (0.1, 5.5) 0.8 (0.1, 5.5) 0.8 (0.1, 5.5) 0.8 (0.1, 5.5)
Modular Stem*
Unipolar Head
Metafix 14 459 2.1 (1.1, 4.2) 3.0 (1.6, 5.7) 3.0 (1.6, 5.7) 7.8 (4.1, 14.6)
(Corin)
Unipolar Head
Taper Fit 18 316 2.2 (1.0, 4.8) 3.5 (1.8, 6.7) 5.6 (3.3, 9.6) 7.1 (4.3, 11.7) 8.0 (4.9, 13.1)
(Corin)
Unipolar Head
Tri-Fit* 8 288 1.5 (0.6, 4.0) 2.1 (0.9, 5.0) 2.7 (1.2, 5.9) 2.7 (1.2, 5.9) 4.8 (2.2, 10.0)
(Corin)
Unipolar Head
Furlong LOL 10 131 6.4 (3.1, 13.0) 9.9 (5.4, 17.7) 9.9 (5.4, 17.7)
(JRI)
Unipolar Head
CCA* 10 357 1.0 (0.3, 3.0) 2.1 (1.0, 4.7) 2.6 (1.2, 5.3) 2.6 (1.2, 5.3) 3.5 (1.7, 7.4) 3.5 (1.7, 7.4)
(Mathys)
Unipolar Head
Fullfix* 8 226 1.5 (0.5, 4.7) 2.7 (1.1, 6.5) 2.7 (1.1, 6.5) 2.7 (1.1, 6.5) 6.1 (2.9, 12.4) 6.1 (2.9, 12.4)
(Mathys)
Unipolar Head
SL-Plus* 8 193 2.2 (0.8, 5.8) 2.9 (1.2, 6.9) 3.6 (1.6, 8.0) 4.6 (2.2, 9.7) 5.9 (2.9, 11.9)
(Plus)
Unipolar Head
Basis 26 578 2.0 (1.1, 3.7) 2.0 (1.1, 3.7) 3.1 (1.8, 5.3) 6.8 (4.5, 10.4) 7.9 (5.3, 11.9) 7.9 (5.3, 11.9)
(S&N)
Unipolar Head
CPCS 113 4626 1.7 (1.4, 2.2) 2.2 (1.8, 2.7) 2.8 (2.2, 3.4) 3.8 (3.1, 4.7) 4.9 (3.8, 6.3) 6.6 (3.8, 11.4)
(S&N)
Unipolar Head
Platform* 6 110 4.1 (1.5, 10.5) 4.1 (1.5, 10.5) 4.1 (1.5, 10.5) 6.0 (2.4, 14.5)
(S&N)
Unipolar Head
SL-Plus 44 1039 2.3 (1.5, 3.5) 3.3 (2.3, 4.8) 4.4 (3.1, 6.1) 5.1 (3.6, 7.1) 6.6 (4.6, 9.6)
(S&N)
Unipolar Head
Spectron EF 96 2851 1.6 (1.1, 2.1) 2.5 (1.9, 3.2) 2.9 (2.2, 3.7) 4.1 (3.3, 5.2) 5.9 (4.6, 7.4) 7.6 (5.8, 9.9)
(S&N)
Unipolar Head
Alloclassic* 60 1084 3.2 (2.3, 4.5) 4.1 (3.0, 5.6) 4.4 (3.2, 5.9) 6.0 (4.5, 7.8) 8.1 (6.2, 10.7) 8.1 (6.2, 10.7)
(Zimmer)
Unipolar Head
CPT* 11 173 1.9 (0.6, 5.8) 3.3 (1.4, 7.7) 4.1 (1.8, 8.8) 5.9 (3.0, 11.7) 7.2 (3.7, 13.8) 9.1 (4.7, 17.0)
(Zimmer)
Unitrax Accolade I* 8 130 0.8 (0.1, 5.6) 5.0 (2.1, 11.6) 6.2 (2.8, 13.3) 6.2 (2.8, 13.3)
Unitrax Exeter V40 440 14097 1.9 (1.6, 2.1) 2.7 (2.4, 3.0) 3.4 (3.1, 3.8) 5.1 (4.6, 5.7) 6.4 (5.7, 7.2) 8.2 (7.0, 9.5)
Unitrax Omnifit* 7 253 2.7 (1.2, 5.9) 3.2 (1.5, 6.7) 3.2 (1.5, 6.7) 3.2 (1.5, 6.7)
VerSys CPT 142 4254 1.9 (1.5, 2.4) 3.0 (2.4, 3.6) 3.5 (2.9, 4.3) 4.7 (3.9, 5.6) 5.9 (4.8, 7.2) 6.5 (5.2, 8.1)
VerSys VerSys 5 168 3.2 (1.2, 8.5) 3.2 (1.2, 8.5) 3.2 (1.2, 8.5)
Other (192) 89 1803 3.5 (2.6, 4.5) 4.7 (3.7, 6.0) 5.4 (4.2, 6.8) 7.2 (5.7, 9.1) 9.2 (7.2, 11.7) 9.9 (7.6, 12.7)
TOTAL 1244 36090
*denotes prosthesis combination with no recorded use in primary unipolar modular hip replacement in 2016


The cumulative percent revision at 10 years for Age, gender and femoral stem fixation are risk
unipolar modular hip replacement, when factors for revision. The rate of revision
undertaken for fractured neck of femur, is 7.5% decreases with increasing age (Table HP20 and
(Table HP17 and Figure HP13). Figure HP14). Males have a higher rate of
revision in the first 1.5 years (Table HP21 and
The Registry has recorded 1,149 revisions of Figure HP15).
primary unipolar modular hip replacement for a
diagnosis of fractured neck of femur. Cementless fixation has a higher rate of revision
compared to cemented fixation (Table HP22
The main reasons for revision are: prosthesis and Figure HP16). The cumulative incidence for
dislocation (19.9%), infection (19.1%), fracture loosening and fracture is higher for cementless
(16.5%), chondrolysis/acetabular erosion compared to cemented fixation (Figure HP17).
(14.3%), loosening (12.6%), and pain (12.4%)
(Table HP18).
The cumulative incidence for loosening and
Most revisions are acetabular only (45.0%), fracture is higher for cementless compared
followed by total hip replacement to cemented fixation.
(femoral/acetabular) (17.8%) (Table HP19).
Table HP17 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement (Primary Diagnosis Fractured NOF)
N N
Revised Total
TOTAL 1149 34286
Figure HP13 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement (Primary Diagnosis Fractured NOF)
20%
Unipolar Modular
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16


a o a .o rg.au 69
Table HP18 Primary Unipolar Modular Hip Replacement Table HP19 Primary Unipolar Modular Hip Replacement
by Reason for Revision (Primary Diagnosis by Type of Revision (Primary Diagnosis
Fractured NOF) Fractured NOF)

Prosthesis Dislocation 229 19.9 Acetabular Component 517 45.0
Infection 220 19.1 THR (Femoral/Acetabular) 205 17.8
Fracture 190 16.5 Head Only 136 11.8
Chondrolysis/Acetab. Erosion 164 14.3 Femoral Component 126 11.0
Loosening 145 12.6 Cement Spacer 48 4.2
Pain 142 12.4 Minor Components 39 3.4
Lysis 15 1.3 Bipolar Head and Femoral 37 3.2
Malposition 3 0.3 Removal of Prostheses 28 2.4
Other 41 3.6 Bipolar Only 8 0.7
TOTAL 1149 100.0 Reinsertion of Components 4 0.3
Cement Only 1 0.1
TOTAL 1149 100.0

component and/or femoral stem is revised
Table HP20 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement by Age (Primary Diagnosis Fractured
NOF)
N N
Revised Total
<75 428 5629 2.7 (2.3, 3.2) 4.6 (4.0, 5.2) 6.3 (5.6, 7.1) 9.2 (8.3, 10.3) 12.1 (10.9, 13.4) 14.3 (12.9, 16.0)
75-84 482 13492 2.2 (1.9, 2.5) 3.1 (2.8, 3.4) 3.6 (3.3, 4.0) 4.8 (4.4, 5.3) 5.9 (5.3, 6.5) 6.6 (5.8, 7.4)
≥85 239 15165 1.5 (1.3, 1.7) 1.8 (1.5, 2.0) 1.9 (1.6, 2.1) 2.3 (2.0, 2.7) 2.6 (2.2, 3.1) 2.6 (2.2, 3.1)
TOTAL 1149 34286
Figure HP14 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement by Age (Primary Diagnosis Fractured
NOF)

20%
<75
<75 vs ≥85
75-84
18% 0 - 3Mth: HR=1.26 (0.96, 1.64),p=0.096
≥85
3Mth - 9Mth: HR=3.58 (2.35, 5.47),p<0.001
16%
9Mth - 1.5Yr: HR=6.72 (4.62, 9.78),p<0.001
14% 1.5Yr - 2Yr: HR=6.58 (4.01, 10.80),p<0.001

2Yr+: HR=9.21 (6.88, 12.33),p<0.001

12%
75-84 vs ≥85
10% 0 - 3Mth: HR=1.09 (0.87, 1.35),p=0.461
3Mth+: HR=3.25 (2.54, 4.16),p<0.001
8%
<75 vs 75-84
6%
0 - 3Mth: HR=1.16 (0.89, 1.51),p=0.285
3Mth - 9Mth: HR=1.10 (0.75, 1.61),p=0.615
4%
9Mth - 1.5Yr: HR=2.07 (1.49, 2.87),p<0.001
2% 1.5Yr - 2Yr: HR=2.03 (1.28, 3.20),p=0.002
2Yr - 2.5Yr: HR=2.98 (1.80, 4.94),p<0.001
0%
2.5Yr+: HR=2.81 (2.24, 3.52),p<0.001
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

<75 5629 4274 3525 2882 1918 1153 434
75-84 13492 9754 7834 6160 3459 1743 476
≥85 15165 9193 6577 4530 1937 702 105

Table HP21 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement by Gender (Primary Diagnosis
Fractured NOF)
N N
Revised Total
Male 347 9801 2.6 (2.2, 2.9) 3.6 (3.2, 4.1) 4.4 (3.9, 4.9) 6.1 (5.4, 6.8) 7.0 (6.1, 8.0) 7.2 (6.3, 8.3)
Female 802 24485 1.8 (1.6, 2.0) 2.5 (2.3, 2.8) 3.2 (2.9, 3.4) 4.5 (4.2, 4.9) 6.1 (5.6, 6.6) 7.5 (6.7, 8.3)
TOTAL 1149 34286
Figure HP15 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement by Gender (Primary Diagnosis
Fractured NOF)

20%
Male
Male vs Female
Female
18% 0 - 1.5Yr: HR=1.37 (1.18, 1.61),p<0.001
1.5Yr+: HR=0.91 (0.73, 1.14),p=0.404

16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Male 9801 5725 4147 2964 1431 712 181
Female 24485 17496 13789 10608 5883 2886 834

a o a .o rg.au 71
Table HP22 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement by Femoral Fixation (Primary Diagnosis
Fractured NOF)
N N
Femoral Fixation 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
Cementless 296 6022 3.0 (2.5, 3.5) 4.1 (3.6, 4.7) 4.8 (4.2, 5.5) 6.3 (5.5, 7.1) 8.3 (7.2, 9.4) 9.3 (7.9, 10.9)
Cemented 853 28264 1.8 (1.6, 1.9) 2.6 (2.4, 2.8) 3.2 (2.9, 3.4) 4.6 (4.2, 4.9) 5.8 (5.4, 6.3) 7.1 (6.4, 7.8)
TOTAL 1149 34286
Figure HP16 Cumulative Percent Revision of Primary Unipolar Modular Hip Replacement by Femoral Fixation (Primary

20%
Cementless
Cemented
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Cementless 6022 4345 3528 2756 1651 887 217
Cemented 28264 18876 14408 10816 5663 2711 798
Figure HP17 Cumulative Incidence Revision Diagnosis of Primary Unipolar Modular Hip Replacement by Femoral Fixation
(Primary Diagnosis Fractured NOF)
Cementless Cemented
3.0% 3.0%
Prosthesis Dislocation Prosthesis Dislocation
Infection Infection
2.5% Fracture 2.5% Fracture
Chondrolysis/Acetab. Erosion Chondrolysis/Acetab. Erosion
Loosening Loosening
Cumulative Incidence
2.0% 2.0%
1.5% 1.5%
1.0% 1.0%
0.5% 0.5%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Years Since Primary Procedure Years Since Primary Procedure

BIPOLAR
DEMOGRAPHICS
There have been 19,163 bipolar hip Figure HP19 Primary Bipolar Hip Replacement by Age
replacement procedures reported to the 100%
Registry. This is an additional 2,120 procedures <55 55-64
90% 65-74 75-84
compared to the previous report. ≥85
80%
Since 2010, there has been an increase in the 70%

number of bipolar procedures undertaken 60%
each year, with 3.8% more procedures in 2016
50%
compared to 2015. The total number of bipolar
procedures has increased by 53.1% since 2003. 40%
30%
Fractured neck of femur is the principal 20%
diagnosis for bipolar hip replacement (91.3%).
10%
The majority of patients are female (71.5%) and 0%
aged 75 years or older (78.0%). The proportion
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
of patients aged 85 years or older has
increased from 26.0% in 2003 to 47.9% in 2016.
The mean age of patients is 80.4 years (Table
HP23, Figures HP18 and HP19). Overall, there have been 261 bipolar head and
stem combinations. In 2016, there were nine
different bipolar head and 40 different stem
Figure HP18 Primary Bipolar Hip Replacement by Gender
prostheses used.
100% In 2016, the UHR remains the most frequently

Male
90% Female used bipolar head (43.5%) and the Exeter V40
80%
the most frequently used femoral stem (41.2%).
The 10 most used femoral stems account for
70%
91.4% of all bipolar hip procedures (Tables HP24
60% and HP25).
50%
40% The cumulative percent revision of bipolar

head/stem prosthesis combinations with more
30%
than 100 procedures is detailed in Table HP26.
20%
10%
0%
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
Table HP23 Age and Gender of Primary Bipolar Hip Replacement

Male 5462 28.5% 17 101 82 79.6 10.9
Female 13701 71.5% 14 107 82 80.8 9.6
TOTAL 19163 100.0% 14 107 82 80.4 10.0

a o a .o rg.au 73
Table HP24 10 Most Used Bipolar Head Prostheses in Primary Bipolar Hip Replacement
2003 2013 2014 2015 2016

760 UHR 596 UHR 779 UHR 815 UHR 894 UHR
140 Hastings 155 Tandem 207 Multipolar Bipolar 759 Multipolar Bipolar 661 Multipolar Bipolar
115 Convene 130 Multipolar Bipolar 115 Tandem 179 Self-Centering 212 Self-Centering
Bipolar Head Bipolar Head
91 46 91 Self-Centering 113 Tandem 154 Tandem
(Zimmer) (Lima)
Bipolar Head Bipolar Head Bipolar Head
87 Self-Centering 38 Hastings 63 69 88
(Medacta) (Medacta) (Medacta)
59 Multipolar Bipolar 35 Self-Centering 35 Hastings 18 Ringloc 23 Bipolar Head (Lima)
39 34 30 Bipolar Head (Lima) 16 Bipolar Head (Lima) 12 Ringloc
(Mathys) (Medacta)
Bipolar Head Bipolar Head Bipolar Head
19 22 Ringloc 28 Ringloc 3 5
(Lima) (Mathys) (Implantcast)
19 Ringloc 8 Moonstone 15 AcuMatch L-Series 2 4
(Implantcast) (Mathys)
5 UHL 8 Pharo 5 Gladiator 2 Hastings
10 Most Used
1334 (10) 99.5% 1072 (10) 98.2% 1368 (10) 99.3% 1976 (10) 99.9% 2053 (9) 100.0%
Remainder
7 (2) 0.5% 20 (7) 1.8% 9 (4) 0.7% 1 (1) 0.1% 0 (0) 0%
TOTAL
1341 (12) 100.0% 1092 (17) 100.0% 1377 (14) 100.0% 1977 (11) 100.0% 2053 (9) 100.0%
Table HP25 10 Most Used Femoral Stem Prostheses in Primary Bipolar Hip Replacement
2003 2013 2014 2015 2016

94 Elite Plus 116 CPCS 170 CPT 662 CPT 600 CPT
75 Alloclassic 106 CPT 91 Corail 124 Corail 127 Corail
65 CPCS 55 Corail 84 CPCS 78 CPCS 125 CPCS
61 C-Stem 28 Quadra-C 39 Accolade I 35 Quadra-C 60 Quadra-C
59 Omnifit 26 C2 27 Quadra-C 26 C-Stem AMT 40 C-Stem AMT
33 VerSys 24 Basis 25 X-Acta 26 X-Acta 22 H-Max
26 ABGII 19 H-Max 20 H-Max 23 Alloclassic 21 Summit
25 CCA 15 Accolade I 16 Alloclassic 22 Accolade I 19 X-Acta
25 Spectron EF 14 Alloclassic 13 C-Stem AMT 22 Summit 18 Accolade II
10 Most Used
1093 (10) 81.5% 980 (10) 89.7% 1219 (10) 88.5% 1795 (10) 90.8% 1877 (10) 91.4%
Remainder
248 (46) 18.5% 112 (33) 10.3% 158 (39) 11.5% 182 (35) 9.2% 176 (30) 8.6%
TOTAL
1341 (56) 100.0% 1092 (43) 100.0% 1377 (49) 100.0% 1977 (45) 100.0% 2053 (40) 100.0%

Table HP26 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Prosthesis Combination
Femoral N N
Bipolar Head 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Component Revised Total
Bipolar Head
Quadra-C 6 206 3.7 (1.7, 8.2) 3.7 (1.7, 8.2) 3.7 (1.7, 8.2)
(Medacta)
Bipolar Head
Alloclassic* 17 358 0.9 (0.3, 2.8) 2.0 (0.9, 4.3) 2.3 (1.1, 4.9) 2.8 (1.4, 5.4) 3.4 (1.7, 6.6) 6.8 (3.8, 12.1)
(Zimmer)
Centrax Exeter* 7 200 2.1 (0.8, 5.5) 2.8 (1.2, 6.5) 2.8 (1.2, 6.5) 2.8 (1.2, 6.5) 2.8 (1.2, 6.5) 3.9 (1.7, 9.0)
Convene CPCS* 16 347 2.2 (1.1, 4.6) 3.3 (1.8, 6.1) 3.3 (1.8, 6.1) 5.2 (3.1, 8.8) 5.9 (3.5, 9.8) 6.7 (4.0, 11.0)
Convene Spectron EF* 8 123 2.6 (0.9, 8.0) 2.6 (0.9, 8.0) 3.8 (1.4, 10.1) 6.6 (2.9, 14.4) 6.6 (2.9, 14.4)
Hastings C-Stem* 10 208 2.5 (1.1, 5.9) 5.0 (2.6, 9.4) 5.7 (3.1, 10.3) 5.7 (3.1, 10.3) 5.7 (3.1, 10.3)
Hastings Charnley* 6 118 0.0 (0.0, 0.0) 3.6 (1.2, 10.8) 3.6 (1.2, 10.8) 6.6 (2.8, 15.3)
Hastings Corail* 17 361 3.3 (1.8, 5.8) 3.6 (2.1, 6.3) 4.0 (2.3, 6.8) 4.7 (2.7, 8.0) 4.7 (2.7, 8.0)
Hastings Elite Plus* 15 298 1.9 (0.8, 4.6) 3.3 (1.6, 6.5) 4.3 (2.3, 7.9) 5.4 (3.1, 9.5) 6.8 (4.0, 11.4) 6.8 (4.0, 11.4)
Hastings Summit* 3 102 2.5 (0.6, 9.6) 2.5 (0.6, 9.6) 2.5 (0.6, 9.6)
Multipolar
Alloclassic 8 190 4.1 (2.0, 8.4) 4.1 (2.0, 8.4) 4.1 (2.0, 8.4) 5.3 (2.6, 10.9)
Bipolar
Multipolar
CPT 60 1958 2.8 (2.1, 3.7) 3.8 (2.9, 5.1) 4.4 (3.2, 5.9) 5.3 (3.7, 7.6) 6.5 (4.1, 10.2)
Bipolar
Multipolar
VerSys 3 237 0.0 (0.0, 0.0) 1.7 (0.4, 6.6) 1.7 (0.4, 6.6) 1.7 (0.4, 6.6) 1.7 (0.4, 6.6)
Bipolar
Multipolar VerSys
11 275 1.7 (0.6, 4.5) 3.2 (1.5, 6.7) 3.2 (1.5, 6.7) 4.0 (2.0, 7.9) 4.0 (2.0, 7.9)
Bipolar Heritage*
Ringloc Mallory-Head 4 113 2.2 (0.6, 8.5) 2.2 (0.6, 8.5) 2.2 (0.6, 8.5)
Self-Centering C-Stem* 3 111 0.0 (0.0, 0.0) 1.2 (0.2, 8.2) 1.2 (0.2, 8.2) 1.2 (0.2, 8.2)
Self-Centering Corail 21 540 3.6 (2.3, 5.8) 4.9 (3.1, 7.7) 4.9 (3.1, 7.7) 4.9 (3.1, 7.7) 6.7 (3.6, 12.3)
Self-Centering Elite Plus* 3 238 0.0 (0.0, 0.0) 0.6 (0.1, 3.9) 0.6 (0.1, 3.9) 1.3 (0.3, 5.2) 2.5 (0.8, 7.8) 2.5 (0.8, 7.8)
Tandem Basis* 13 114 2.0 (0.5, 7.7) 7.5 (3.7, 15.2) 12.5 (7.1, 21.5)
Tandem CPCS 31 1245 1.8 (1.1, 2.8) 2.4 (1.6, 3.6) 2.9 (2.0, 4.3) 3.1 (2.1, 4.6) 4.3 (2.8, 6.4) 4.9 (3.2, 7.5)
Tandem Spectron EF 7 163 2.7 (1.0, 7.1) 3.7 (1.5, 8.6) 4.6 (2.1, 10.0) 5.8 (2.8, 12.1)
UHR ABGII* 20 177 4.4 (2.1, 8.9) 4.4 (2.1, 8.9) 5.1 (2.6, 10.1) 10.9 (6.5, 18.0) 13.5 (8.3, 21.6)
UHR Accolade I 16 313 2.8 (1.4, 5.5) 4.2 (2.3, 7.4) 4.7 (2.7, 8.2) 5.4 (3.1, 9.4) 6.7 (3.8, 11.9)
UHR Exeter V40 223 7946 1.9 (1.6, 2.3) 2.5 (2.2, 3.0) 3.1 (2.7, 3.6) 3.7 (3.2, 4.2) 4.3 (3.7, 5.0) 5.0 (4.2, 5.9)
UHR Exeter* 10 205 1.6 (0.5, 4.9) 2.2 (0.8, 5.8) 3.5 (1.6, 7.7) 4.9 (2.5, 9.7) 4.9 (2.5, 9.7) 4.9 (2.5, 9.7)
UHR GMRS 10 117 3.7 (1.4, 9.6) 5.2 (2.2, 12.4) 5.2 (2.2, 12.4)
UHR Omnifit 22 372 4.9 (3.1, 7.8) 5.3 (3.4, 8.3) 5.7 (3.6, 8.7) 6.1 (4.0, 9.3) 7.3 (4.8, 11.1) 7.3 (4.8, 11.1)
Other (234) 116 2528 3.2 (2.5, 4.0) 4.0 (3.3, 5.0) 4.9 (4.0, 5.9) 5.6 (4.6, 6.8) 6.2 (5.1, 7.6) 8.2 (6.6, 10.3)
TOTAL 686 19163
*denotes prosthesis combination with no recorded use in primary bipolar hip replacement in 2016

a o a .o rg.au 75

The cumulative percent revision at 10 years for Age and femoral stem fixation are risk factors
bipolar hip replacement undertaken for for revision. Patients aged less than 75 years
fractured neck of femur is 6.4% (Table HP27 and have a higher rate of revision compared to the
Figure HP20). two older age groups (Table HP30 and Figure
HP21). There is no difference in outcome
The Registry has recorded 606 revisions of between males and females (Table HP31 and
primary bipolar hip replacement procedures Figure HP22).
with a primary diagnosis of fractured neck of
femur. Cementless fixation has a higher rate of revision
compared to cemented fixation (Table HP32
The main reasons for revision are fracture and Figure HP23). The cumulative incidence of
(24.9%), infection (21.0%), prosthesis dislocation fracture for cementless fixation is higher than for
(18.3%), and loosening (16.7%) (Table HP28). The cemented fixation (Figure HP24).
most frequent type of revision is acetabular only
(34.7%), followed by total hip replacement
(femoral/acetabular) (22.8%), and bipolar head
and femoral (12.9%) (Table HP29). Cementless fixation has a higher rate of
revision compared to cemented fixation.
Table HP27 Cumulative Percent Revision of Primary Bipolar Hip Replacement (Primary Diagnosis Fractured NOF)
N N
Revised Total
Bipolar 606 17486 2.3 (2.0, 2.5) 3.1 (2.8, 3.4) 3.7 (3.4, 4.0) 4.4 (4.0, 4.8) 5.0 (4.6, 5.5) 6.4 (5.7, 7.0)
TOTAL 606 17486
Figure HP20 Cumulative Percent Revision of Primary Bipolar Hip Replacement (Primary Diagnosis Fractured NOF)
20%
Bipolar
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Bipolar 17486 12050 9300 7415 4866 3191 1598

Table HP28 Primary Bipolar Hip Replacement by Reason Table HP29 Primary Bipolar Hip Replacement by Type of
for Revision Revision

Fracture 151 24.9 Acetabular Component 210 34.7
Prosthesis Dislocation 111 18.3 Bipolar Head and Femoral 78 12.9
Loosening 101 16.7 Bipolar Only 72 11.9
Chondrolysis/Acetab. Erosion 48 7.9 Femoral Component 35 5.8
Malposition 3 0.5 Removal of Prostheses 15 2.5
Lysis 2 0.3 Head Only 14 2.3
Other 18 3.0 Minor Components 12 2.0
TOTAL 606 100.0 TOTAL 606 100.0

component and/or femoral stem is revised
Table HP30 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Age (Primary Diagnosis Fractured NOF)
N N
Revised Total
<75 213 3528 2.8 (2.3, 3.4) 4.4 (3.7, 5.2) 5.4 (4.6, 6.3) 6.4 (5.5, 7.4) 7.8 (6.7, 9.0) 9.2 (8.0, 10.6)
75-84 236 6987 2.2 (1.8, 2.5) 3.0 (2.6, 3.5) 3.4 (2.9, 3.9) 4.1 (3.6, 4.7) 4.3 (3.8, 5.0) 5.6 (4.8, 6.5)
≥85 157 6971 2.1 (1.7, 2.5) 2.2 (1.9, 2.7) 2.9 (2.4, 3.4) 3.3 (2.8, 3.9) 3.6 (2.9, 4.3) 4.7 (3.4, 6.5)
TOTAL 606 17486
Figure HP21 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Age (Primary Diagnosis Fractured NOF)

20%
<75
<75 vs ≥85
75-84
18% 0 - 1Yr: HR=1.43 (1.10, 1.87),p=0.008
≥85
1Yr - 1.5Yr: HR=3.73 (2.07, 6.73),p<0.001
16%
1.5Yr+: HR=2.28 (1.68, 3.11),p<0.001
14%
75-84 vs ≥85
10% <75 vs 75-84

8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

<75 3528 2701 2211 1919 1479 1150 719
75-84 6987 5102 4078 3380 2324 1539 733
≥85 6971 4247 3011 2116 1063 502 146

a o a .o rg.au 77
Table HP31 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Gender (Primary Diagnosis Fractured NOF)
N N
Revised Total
Male 168 4905 2.5 (2.1, 3.0) 3.6 (3.0, 4.2) 4.5 (3.8, 5.4) 5.4 (4.6, 6.4) 5.8 (4.9, 6.9) 7.2 (5.8, 8.8)
Female 438 12581 2.2 (1.9, 2.5) 2.9 (2.6, 3.3) 3.4 (3.1, 3.8) 4.1 (3.7, 4.5) 4.8 (4.3, 5.3) 6.1 (5.4, 6.8)
TOTAL 606 17486
Figure HP22 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Gender (Primary Diagnosis Fractured NOF)

20%
Male
Male vs Female
Female
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Male 4905 2950 2111 1569 913 565 276
Female 12581 9100 7189 5846 3953 2626 1322

Table HP32 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Femoral Fixation (Primary Diagnosis Fractured
NOF)
N N
Femoral Fixation 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
Cementless 162 3192 3.3 (2.7, 4.1) 4.2 (3.5, 5.0) 4.9 (4.1, 5.8) 5.9 (5.0, 7.0) 6.7 (5.6, 8.0) 9.3 (7.6, 11.3)
Cemented 444 14294 2.0 (1.8, 2.3) 2.8 (2.5, 3.1) 3.4 (3.1, 3.8) 4.0 (3.6, 4.5) 4.6 (4.2, 5.2) 5.7 (5.1, 6.4)
TOTAL 606 17486
Figure HP23 Cumulative Percent Revision of Primary Bipolar Hip Replacement by Femoral Fixation (Primary Diagnosis
Fractured NOF)

20%
Cementless
Cemented
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Cementless 3192 2273 1794 1428 889 563 281
Cemented 14294 9777 7506 5987 3977 2628 1317
Figure HP24 Cumulative Incidence Revision Diagnosis of Primary Bipolar Hip Replacement by Femoral Fixation (Primary
Cementless Cemented
5.0% 5.0%
Fracture Fracture
Infection Infection
4.0% Loosening 4.0% Loosening
Chondrolysis/Acetab. Erosion Chondrolysis/Acetab. Erosion
3.0% 3.0%
2.0% 2.0%
1.0% 1.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

a o a .o rg.au 79
Primary Total Hip Replacement

CLASSES OF TOTAL HIP REPLACEMENT USE OF TOTAL HIP REPLACEMENT
The Registry sub-categorises primary total hip The Registry has recorded 400,331 primary total
replacement into three classes. These are hip replacement procedures. Of these, total
defined by the type of femoral prosthesis used. conventional is the most common class (95.8%)
A total hip procedure replaces both the followed by total resurfacing (4.2%) (Table HT1).
femoral and acetabular articular surfaces. Previously, the Registry has included the thrust
plate in primary total hip replacement, but as
Total conventional involves acetabular there has been no use for four years and the
replacement combined with resection of the use of the thrust plate is less than 0.1% of all
femoral head and replacement with a primary total hip replacements, it has been
stemmed femoral prosthesis and femoral head excluded from further analysis.
prosthesis.
Total resurfacing involves acetabular
replacement and the use of a femoral Table HT1 Primary Total Hip Replacement by Class
prosthesis that replaces the femoral articular Total Hip Class Number Percent
surface without resecting the head.
Total Conventional 383123 95.8
Thrust plate involves acetabular replacement
Total Resurfacing 16950 4.2
combined with resection of the femoral head
and replacement with a femoral component TOTAL 400073 100.0
that has a lateral fixation plate and femoral
Note: Excludes 258 thrust plate procedures
head prosthesis.
Detailed information on Thrust Plate is available in the supplementary
report ‘Outcome of Classes No Longer Used - Hip and Knee Arthroplasty’
on the AOANJRR website:
Osteoarthritis is the principal diagnosis for

primary total hip replacement (88.8%).
Total conventional hip replacement (all bearing

surfaces included) has a lower cumulative
percent revision compared to total resurfacing
at 16 years (Table HT2).
Detailed demographic information on primary total hip replacement is

Shoulder Arthroplasty’ on the AOANJRR website:
Table HT2 Cumulative Percent Revision of Primary Total Hip Replacement by Class
N N
Total Hip Class 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Total Conventional 17003 383123 1.7 (1.6, 1.7) 2.8 (2.7, 2.8) 3.8 (3.7, 3.9) 6.6 (6.5, 6.8) 9.8 (9.5, 10.0) 10.4 (10.0, 10.7)
Total Resurfacing 1565 16950 1.7 (1.5, 1.9) 3.3 (3.0, 3.6) 5.1 (4.8, 5.4) 9.8 (9.3, 10.3) 13.5 (12.7, 14.3) 14.2 (13.0, 15.5)
TOTAL 18568 400073

PRIMARY TOTAL CONVENTIONAL HIP REPLACEMENT

DEMOGRAPHICS
There have been 383,123 total conventional hip Figure HT2 Primary Total Conventional Hip Replacement
by Age
replacement procedures reported to the
Registry. This is an additional 36,341 procedures 100%
<55 55-64
compared to the previous report. 65-74 75-84
90%
≥85
80%
Primary total conventional hip replacement
continues to increase. In 2016, there were 5.5% 70%
more procedures than in 2015 and 109.7% more 60%
than in 2003.
50%
Total conventional hip replacement is more 40%
common in females (55.0%). This proportion has 30%

remained stable since 2003 (Figure HT1). 20%
10%
0%
Figure HT1 Primary Total Conventional Hip Replacement
03
04
05
06
07
08
09
10
11
12
13
14
15
16
by Gender
20
20
20
20
20
20
20
20
20
20
20
20
20
20
100%
Male
90% Female
80% The use of cementless fixation has increased

70%
from 51.3% in 2003 to 63.4% in 2016. Cemented
fixation has declined from 13.9% to 3.4% and
60%
hybrid fixation from 34.8% to 33.2% over the
50% same period (Figure HT3).
40%
30%
20% Figure HT3 Primary Total Conventional Hip Replacement

by Fixation
10%
0% 100%
Cemented
90% Cementless
03
04
05
06
07
08
09
10
11
12
13
14
15
16
Hybrid
20
20
20
20
20
20
20
20
20
20
20
20
20
20
80%
70%
60%
The mean age of patients is 67.7 years. There
has been minimal change in the proportion of 50%
patients aged 55 to 64 years (21.9% in 2003 to 40%

24.0% in 2016) and younger than 55 years 30%
(11.7% in 2003 to 12.6% in 2016) (Table HT3 and
20%
Figure HT2).
10%
0%
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
Table HT3 Age and Gender of Primary Total Conventional Hip Replacement

Male 172435 45.0% 13 102 67 66.3 11.5
Female 210688 55.0% 11 101 70 68.9 11.4
TOTAL 383123 100.0% 11 102 69 67.7 11.5

a o a .o rg.au 81
The Exeter V40, Corail, Quadra-H, and The Trident (Shell), Pinnacle, and R3 remain the
Polarstem are the most used femoral stems for most frequently used acetabular prostheses for
total conventional hip replacement (Table HT4). total conventional hip replacement. In 2016,
In 2016, 66.0% of total conventional hip 78.5% of total conventional hip procedures
replacements used stems in the 10 most used used acetabular components from the 10 most
femoral component list. Seven of these are used list (Table HT7). All of the acetabular
cementless. The 10 most used cemented and components in this list are cementless
cementless stems are listed in Tables HT5 and prostheses. The 10 most used cemented and
HT6, respectively. In 2016, the 10 most used cementless acetabular prostheses are listed
cemented stems accounted for 92.8% of separately in Tables HT8 and HT9.
cemented stem procedures. The ten most used
cementless stems accounted for 70.5% of
cementless stem procedures.
Table HT4 10 Most Used Femoral Components in Primary Total Conventional Hip Replacement
2003 2013 2014 2015 2016

1029 ABGII 4668 Corail 5036 Corail 5411 Corail 5815 Corail
1000 Synergy 2259 Quadra-H 2916 Quadra-H 2828 Quadra-H 2736 Quadra-H
819 Alloclassic 1462 CPT 1565 CPT 1517 Polarstem 1813 Polarstem
809 VerSys 1048 Polarstem 1201 Polarstem 1295 CPT 1315 Accolade II
780 Spectron EF 813 Secur-Fit 841 Anthology 905 Accolade II 1216 CPT
713 Secur-Fit Plus 785 CPCS 726 CPCS 842 Taperloc 982 Taperloc
618 Omnifit 765 Accolade I 716 Secur-Fit 811 CPCS 790 CPCS
565 C-Stem 731 Synergy 715 Taperloc 778 Anthology 780 Tri-Fit TS
485 S-Rom 643 Anthology 574 Synergy 579 Tri-Fit TS 779 AMIStem H
10 Most Used
10719 (10) 62.8% 20106 (10) 68.0% 21696 (10) 67.3% 22421 (10) 66.1% 23645 (10) 66.0%
Remainder
6354 (73) 37.2% 9463 (109) 32.0% 10539 (109) 32.7% 11521 (98) 33.9% 12160 (91) 34.0%
TOTAL
17073 (83) 100.0% 29569 (119) 100.0% 32235 (119) 100.0% 33942 (108) 100.0% 35805 (101) 100.0%
Table HT5 10 Most Used Cemented Femoral Components in Primary Total Conventional Hip Replacement
2003 2013 2014 2015 2016

780 Spectron EF 1462 CPT 1565 CPT 1295 CPT 1216 CPT
565 C-Stem 785 CPCS 726 CPCS 811 CPCS 790 CPCS
477 CPT 327 C-Stem AMT 381 C-Stem AMT 412 C-Stem AMT 612 C-Stem AMT
445 Elite Plus 317 Spectron EF 276 Spectron EF 332 MS 30 506 Short Exeter V40
358 MS 30 246 Omnifit 237 MS 30 286 Quadra-C 409 Quadra-C
338 Omnifit 165 MS 30 189 Quadra-C 271 Evolve 363 Evolve
321 Charnley 118 Quadra-C 185 Omnifit 263 Short Exeter V40 352 MS 30
245 CPCS 106 C-Stem 157 Evolve 241 Spectron EF 224 Taper Fit
123 Exeter 74 Absolut 123 Absolut 161 Taper Fit 180 Spectron EF
10 Most Used
7553 (10) 91.7% 10532 (10) 97.2% 11245 (10) 95.3% 11527 (10) 92.9% 12071 (10) 92.8%
Remainder
680 (26) 8.3% 305 (29) 2.8% 558 (28) 4.7% 885 (24) 7.1% 931 (17) 7.2%
TOTAL
8233 (36) 100.0% 10837 (39) 100.0% 11803 (38) 100.0% 12412 (34) 100.0% 13002 (27) 100.0%

Table HT6 10 Most Used Cementless Femoral Components in Primary Total Conventional Hip Replacement
2003 2013 2014 2015 2016

1029 ABGII 4668 Corail 5036 Corail 5411 Corail 5815 Corail
980 Synergy 2259 Quadra-H 2916 Quadra-H 2828 Quadra-H 2736 Quadra-H
819 Alloclassic 1048 Polarstem 1201 Polarstem 1517 Polarstem 1813 Polarstem
739 VerSys 813 Secur-Fit 841 Anthology 905 Accolade II 1315 Accolade II
713 Secur-Fit Plus 765 Accolade I 716 Secur-Fit 842 Taperloc 982 Taperloc
485 S-Rom 731 Synergy 715 Taperloc 778 Anthology 780 Tri-Fit TS
482 Secur-Fit 643 Anthology 574 Synergy 579 Tri-Fit TS 779 AMIStem H
376 Corail 609 Taperloc 530 M/L Taper 565 Avenir 687 Anthology
334 Accolade I 448 Alloclassic 523 Accolade II 551 Secur-Fit 638 Metafix
334 Mallory-Head 433 Summit 477 Summit 474 Metafix 537 Paragon
10 Most Used
6291 (10) 71.2% 12417 (10) 66.3% 13529 (10) 66.2% 14450 (10) 67.1% 16082 (10) 70.5%
Remainder
2549 (47) 28.8% 6315 (82) 33.7% 6903 (81) 33.8% 7080 (74) 32.9% 6721 (72) 29.5%
TOTAL
8840 (57) 100.0% 18732 (92) 100.0% 20432 (91) 100.0% 21530 (84) 100.0% 22803 (82) 100.0%
Table HT7 10 Most Used Acetabular Components in Primary Total Conventional Hip Replacement
2003 2013 2014 2015 2016

3986 Trident (Shell) 7020 Trident (Shell) 7346 Trident (Shell) 7463 Trident (Shell) 7762 Trident (Shell)
1748 Reflection (Shell) 5653 Pinnacle 6157 Pinnacle 6606 Pinnacle 6882 Pinnacle
1524 Trilogy 3340 R3 3448 R3 3632 R3 3717 R3
955 Vitalock 2133 Versafitcup CC 2820 Versafitcup CC 3014 Versafitcup CC 2731 Versafitcup CC
907 Duraloc 1502 Continuum 1492 Continuum 1573 Trinity 1969 Trinity
827 ABGII 1022 Trilogy 1322 Trinity 1359 Continuum 1297 Continuum
793 Allofit 778 Trinity 1092 Trilogy 884 Trilogy 1123 Mpact
Trident/Tritanium Trident/Tritanium
729 Mallory-Head 644 Allofit 652 Exeter X3 Rimfit 768 1093
(Shell) (Shell)
Trident/Tritanium Trident/Tritanium Acetabular Shell
539 Contemporary 630 648 633 786 Logical G
(Shell) (Shell) (Global)
Acetabular Shell
537 Pinnacle 563 Delta-TT 611 Allofit 608 Exeter X3 Rimfit 746
(Global)
10 Most Used
12545 (10) 73.5% 23285 (10) 78.7% 25588 (10) 79.4% 26540 (10) 78.2% 28106 (10) 78.5%
Remainder
4528 (69) 26.5% 6284 (69) 21.3% 6647 (77) 20.6% 7402 (67) 21.8% 7699 (68) 21.5%
TOTAL
17073 (79) 100.0% 29569 (79) 100.0% 32235 (87) 100.0% 33942 (77) 100.0% 35805 (78) 100.0%

a o a .o rg.au 83
Table HT8 10 Most Used Cemented Acetabular Components in Primary Total Conventional Hip Replacement
2003 2013 2014 2015 2016

539 Contemporary 544 Exeter X3 Rimfit 652 Exeter X3 Rimfit 608 Exeter X3 Rimfit 535 Exeter X3 Rimfit
256 Exeter 222 Contemporary 234 Contemporary 181 Contemporary 138 Contemporary
251 Reflection (Cup) 130 Marathon 135 Marathon 130 Marathon 116 Marathon
Exeter Exeter
227 111 Brunswick 103 ZCA 104 ZCA 104
Contemporary Contemporary
Exeter
199 Charnley Ogee 108 75 Reflection (Cup) 81 Reflection (Cup) 76 ZCA
Contemporary
149 Elite Plus LPW 97 ZCA 58 Exeter Contemporary 52 Exeter Contemporary 65 Reflection (Cup)
130 Low Profile Cup 82 Reflection (Cup) 37 Brunswick 21 CCB 36 Muller
110 Elite Plus Ogee 28 Low Profile Cup 19 CCB 20 Low Profile Cup 24 Avantage
102 Charnley 19 CCB 19 Low Profile Cup 17 Muller 17 Low Profile Cup
90 ZCA 12 Durasul 12 Polarcup 12 Polarcup 15 Polarcup
10 Most Used
2053 (10) 85.4% 1353 (10) 97.3% 1344 (10) 94.7% 1226 (10) 96.2% 1126 (10) 92.8%
Remainder
351 (16) 14.6% 37 (11) 2.7% 75 (17) 5.3% 49 (14) 3.8% 87 (14) 7.2%
TOTAL
2404 (26) 100.0% 1390 (21) 100.0% 1419 (27) 100.0% 1275 (24) 100.0% 1213 (24) 100.0%
Table HT9 10 Most Used Cementless Acetabular Components in Primary Total Conventional Hip Replacement
2003 2013 2014 2015 2016

3986 Trident (Shell) 7020 Trident (Shell) 7346 Trident (Shell) 7462 Trident (Shell) 7760 Trident (Shell)
1748 Reflection (Shell) 5653 Pinnacle 6157 Pinnacle 6606 Pinnacle 6882 Pinnacle
1524 Trilogy 3340 R3 3448 R3 3632 R3 3717 R3
955 Vitalock 2133 Versafitcup CC 2820 Versafitcup CC 3013 Versafitcup CC 2731 Versafitcup CC
907 Duraloc 1502 Continuum 1492 Continuum 1573 Trinity 1969 Trinity
827 ABGII 1022 Trilogy 1322 Trinity 1359 Continuum 1297 Continuum
793 Allofit 778 Trinity 1092 Trilogy 884 Trilogy 1123 Mpact
Trident/Tritanium Trident/Tritanium Trident/Tritanium
729 Mallory-Head 644 Allofit 648 768 1093
(Shell) (Shell) (Shell)
Trident/Tritanium Acetabular Shell
537 Pinnacle 629 611 Allofit 633 786 Logical G
(Shell) (Global)
Acetabular Shell Acetabular Shell
521 Fitmore 563 Delta-TT 454 538 G7 746
(Global) (Global)
10 Most Used
12527 (10) 85.4% 23284 (10) 82.6% 25390 (10) 82.4% 26468 (10) 81.0% 28104 (10) 81.2%
Remainder
2142 (43) 14.6% 4895 (54) 17.4% 5426 (55) 17.6% 6199 (52) 19.0% 6488 (52) 18.8%
TOTAL
14669 (53) 100.0% 28179 (64) 100.0% 30816 (65) 100.0% 32667 (62) 100.0% 34592 (62) 100.0%

OUTCOME FOR ALL DIAGNOSES

Since 2014, the Registry has excluded large Osteoarthritis is the principal diagnosis (88.5%),
head metal/metal bearings from many followed by fractured neck of femur (4.3%),
analyses of primary total conventional hip osteonecrosis (3.3%), developmental dysplasia
replacement outcomes. It is a bearing that is no (1.2%) and rheumatoid arthritis (1.0%) (Table
longer used; it accounts for an increasingly HT10).
small proportion of procedures (currently 4.3%)
and it has a much higher revision rate than any Osteoarthritis has a lower rate of revision
other bearing used (30.0% at 15 years). In compared to fractured neck of femur,
addition, it was also preferentially used in osteonecrosis and rheumatoid arthritis. It also
younger patients with cementless fixation and has a lower rate of revision compared to
with particular femoral stem and acetabular developmental dysplasia. However, this
prosthesis combinations. difference is only evident in the first month
(Figure HT4).
Consequently, in specific analyses it has the
potential to be a major confounding factor. It is
almost always excluded from general analyses.
In prosthesis specific analyses, prostheses with
large head metal/metal bearings are identified
separately. The Registry clearly identifies
whether large head metal/metal bearings are
excluded in any analyses.

a o a .o rg.au 85
Table HT10 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Primary Diagnosis
N N
Primary Diagnosis 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Osteoarthritis 11610 324627 1.5 (1.5, 1.6) 2.4 (2.4, 2.5) 3.1 (3.0, 3.2) 5.1 (5.0, 5.2) 8.1 (7.8, 8.3) 8.8 (8.4, 9.1)
Fractured Neck Of Femur 763 15865 3.0 (2.8, 3.3) 4.5 (4.1, 4.8) 5.4 (5.0, 5.8) 7.9 (7.2, 8.6) 11.1 (9.3, 13.2)
Osteonecrosis 623 12051 2.6 (2.3, 2.9) 3.7 (3.4, 4.1) 4.5 (4.1, 4.9) 7.3 (6.6, 8.0) 10.8 (9.5, 12.2) 11.1 (9.7, 12.7)
Developmental Dysplasia 228 4556 2.2 (1.8, 2.7) 3.3 (2.8, 3.9) 3.9 (3.4, 4.6) 6.0 (5.2, 6.9) 10.8 (8.9, 13.1) 10.8 (8.9, 13.1)
Rheumatoid Arthritis 205 3733 2.2 (1.8, 2.8) 3.5 (3.0, 4.2) 4.2 (3.5, 4.9) 6.8 (5.8, 7.9) 10.4 (8.7, 12.3) 10.4 (8.7, 12.3)
Tumour 103 2077 4.0 (3.2, 5.1) 6.6 (5.2, 8.3) 8.3 (6.5, 10.5) 13.4 (9.7, 18.4)
Other (5) 232 3915 3.4 (2.9, 4.0) 4.8 (4.2, 5.6) 5.9 (5.1, 6.7) 8.4 (7.2, 9.7) 11.0 (9.1, 13.3)
TOTAL 13764 366824
Note: Only primary diagnoses with over 2,000 procedures have been listed
All procedures using metal/metal prostheses with head size larger than 32mm have been excluded
Figure HT4 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Primary Diagnosis

24%
Osteoarthritis
Fractured Neck Of Femur vs Osteoarthritis
22% Fractured Neck Of Femur
Osteonecrosis 0 - 2Wk: HR=1.58 (1.22, 2.04),p<0.001
20% Developmental Dysplasia 2Wk - 3Mth: HR=2.44 (2.15, 2.77),p<0.001
Rheumatoid Arthritis 3Mth - 1.5Yr: HR=1.87 (1.61, 2.16),p<0.001
18%
1.5Yr+: HR=1.42 (1.25, 1.62),p<0.001
16%
Osteonecrosis vs Osteoarthritis
14%
0 - 6Mth: HR=1.50 (1.31, 1.72),p<0.001
12% 6Mth - 9Mth: HR=2.66 (2.00, 3.54),p<0.001
9Mth - 1.5Yr: HR=1.29 (0.99, 1.68),p=0.059
10%
1.5Yr+: HR=1.25 (1.11, 1.40),p<0.001
8%
Developmental Dysplasia vs Osteoarthritis
6%
0 - 2Wk: HR=2.29 (1.57, 3.34),p<0.001
4% 2Wk - 1Mth: HR=1.62 (1.10, 2.37),p=0.014

1Mth+: HR=1.11 (0.96, 1.30),p=0.170
2%
0% Rheumatoid Arthritis vs Osteoarthritis

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Entire Period: HR=1.34 (1.16, 1.53),p<0.001

Osteoarthritis 324627 285535 219001 162111 61303 6575 1649
Fractured Neck Of Femur 15865 12450 8199 5149 1120 91 17
Osteonecrosis 12051 10463 8045 6051 2435 322 87
Developmental Dysplasia 4556 3994 3138 2459 1212 181 45
Rheumatoid Arthritis 3733 3367 2769 2201 1039 156 57

PROSTHESIS TYPES
There are 2,844 different stem and acetabular There are 10 total conventional stem and
combinations for primary total conventional hip acetabular combinations with more than 500
replacement recorded by the Registry. This is an procedures using cemented fixation. The MS
additional 157 prosthesis combinations since 30/Low Profile Cup has the lowest 15 year
the previous report. Metal/metal prostheses cumulative percent revision of 5.3% (Table
with head size larger than 32mm are included HT11).
in these combinations.
There are 74 cementless total conventional
The cumulative percent revision of the 115 stem and acetabular combinations listed. The
prosthesis combinations with more than 500 Secur-Fit Plus/Trident (Shell) has the lowest 16
procedures is listed in Tables HT11 to HT13. year cumulative percent revision of 4.6% (Table
Although the listed combinations are a small HT12).
proportion of the possible combinations, they
represent 81.5% of all primary total There are 31 combinations of total
conventional hip replacement procedures. conventional hip replacement prostheses with
hybrid fixation. The Exeter/Vitalock has the
The ‘Other’ group consists of all prosthesis lowest cumulative percent revision at 16 years
combinations with less than 500 procedures. (7.3%) (Table HT13).
This group accounts for 18.5% of all primary total
conventional hip replacement procedures.
Table HT11 Cumulative Percent Revision of Primary Total Conventional Hip Replacement with Cemented Fixation
CPCS Reflection (Cup) 60 918 1.2 (0.7, 2.2) 2.3 (1.5, 3.7) 3.2 (2.1, 4.7) 8.7 (6.4, 11.8)
CPT ZCA 37 915 0.8 (0.4, 1.6) 2.2 (1.4, 3.5) 3.0 (2.0, 4.4) 5.1 (3.5, 7.4) 8.5 (5.5, 12.9)
Charnley Charnley Ogee* 59 709 1.0 (0.5, 2.1) 3.0 (1.9, 4.5) 4.8 (3.4, 6.7) 8.1 (6.1, 10.6) 13.0 (9.7, 17.4)
Charnley Charnley* 39 591 0.5 (0.2, 1.6) 1.0 (0.5, 2.3) 2.2 (1.2, 3.8) 6.3 (4.4, 9.0) 11.1 (7.9, 15.5)
Exeter V40 Contemporary 272 5428 1.7 (1.4, 2.1) 2.9 (2.5, 3.4) 3.6 (3.1, 4.1) 6.3 (5.5, 7.2) 9.2 (7.8, 10.8)
Exeter V40 Exeter Contemporary 136 3289 1.4 (1.0, 1.9) 2.3 (1.8, 2.9) 3.0 (2.4, 3.7) 4.7 (3.9, 5.7)
Exeter V40 Exeter X3 Rimfit 64 3027 1.4 (1.0, 1.9) 2.4 (1.9, 3.1) 2.7 (2.1, 3.5)
Exeter V40 Exeter* 88 1712 0.8 (0.5, 1.4) 1.9 (1.3, 2.7) 3.1 (2.4, 4.1) 4.9 (3.9, 6.2) 8.5 (6.6, 10.9)
MS 30 Low Profile Cup 20 715 0.6 (0.2, 1.5) 0.7 (0.3, 1.8) 1.1 (0.5, 2.3) 2.6 (1.5, 4.6) 5.3 (3.0, 9.2)
Spectron EF Reflection (Cup) 113 1654 1.0 (0.7, 1.7) 1.6 (1.1, 2.4) 2.7 (2.0, 3.6) 7.1 (5.7, 8.8) 16.5 (13.1, 20.6)
Other (458) 518 9603 1.7 (1.4, 2.0) 2.7 (2.4, 3.1) 3.9 (3.5, 4.3) 6.7 (6.0, 7.4) 10.9 (9.9, 12.1) 11.8 (10.4, 13.3)
TOTAL 1406 28561
Note: In the ‘Other’ group, there are some cementless components that have been inserted with cement
Only combinations with over 500 procedures have been listed
Procedures using metal/metal prostheses with head size larger than 32mm have been included

a o a .o rg.au 87
Table HT12 Cumulative Percent Revision of Primary Total Conventional Hip Replacement with Cementless Fixation
ABGII ABGII 253 2968 1.8 (1.4, 2.4) 3.1 (2.5, 3.8) 4.2 (3.5, 5.0) 6.8 (5.9, 7.9) 11.4 (10.1, 13.0) 12.2 (10.5, 14.2)
ABGII
ABGII 62 894 1.5 (0.9, 2.5) 2.3 (1.5, 3.5) 2.9 (2.0, 4.2) 6.8 (5.1, 8.9)
(Shell/Insert)
ABGII Trident (Shell) 201 2514 2.8 (2.2, 3.5) 4.3 (3.6, 5.2) 5.3 (4.4, 6.2) 8.9 (7.7, 10.3)
AMIStem H Versafitcup CC 17 1164 1.0 (0.6, 2.0) 2.4 (1.1, 5.3) 3.5 (1.5, 7.8)
Accolade I Trident (Shell) 451 9248 1.7 (1.5, 2.0) 3.0 (2.7, 3.4) 3.8 (3.4, 4.2) 5.8 (5.3, 6.4)
Trident/
Accolade I Tritanium 26 756 1.3 (0.7, 2.4) 2.4 (1.5, 3.8) 3.7 (2.4, 5.5)
(Shell)*
Accolade II Trident (Shell) 36 2408 1.4 (0.9, 2.0) 2.1 (1.5, 3.0)
Alloclassic Allofit 268 5700 1.4 (1.2, 1.8) 2.3 (1.9, 2.7) 3.0 (2.6, 3.5) 5.3 (4.7, 6.0) 8.8 (7.3, 10.5)
Alloclassic DuromMoM* 86 621 1.3 (0.7, 2.6) 5.0 (3.5, 7.0) 7.1 (5.3, 9.4) 15.4 (12.5, 19.0)
Alloclassic Fitmore 131 1883 3.3 (2.6, 4.2) 4.7 (3.8, 5.8) 5.7 (4.7, 6.9) 7.6 (6.4, 9.1) 10.1 (7.6, 13.3)
Trabecular
Alloclassic 41 1064 2.4 (1.6, 3.5) 3.0 (2.1, 4.2) 3.8 (2.8, 5.2) 4.3 (3.1, 5.8)
Metal (Shell)
Alloclassic Trilogy 17 943 0.6 (0.3, 1.4) 0.9 (0.4, 1.8) 1.2 (0.6, 2.1) 3.0 (1.8, 5.2)
Anthology R3 118 5441 1.7 (1.4, 2.1) 2.0 (1.7, 2.5) 2.3 (1.9, 2.8)
Reflection
Anthology 35 990 1.8 (1.2, 2.9) 2.2 (1.4, 3.3) 3.0 (2.1, 4.4) 4.4 (3.1, 6.1)
(Shell)
Apex Fin II* 43 1008 1.9 (1.2, 2.9) 2.5 (1.7, 3.7) 3.8 (2.8, 5.3) 5.6 (4.1, 7.6)
Avenir Continuum 23 1114 2.0 (1.3, 3.0) 2.1 (1.4, 3.2) 2.1 (1.4, 3.2)
Avenir Trilogy 6 601 0.8 (0.3, 2.0) 1.0 (0.5, 2.3) 1.0 (0.5, 2.3)
C2 Delta-TT 12 604 1.1 (0.5, 2.3) 2.0 (1.1, 3.7) 3.0 (1.6, 5.5)
CLS Allofit 53 860 1.5 (0.9, 2.6) 3.4 (2.4, 4.9) 3.8 (2.7, 5.4) 6.5 (4.9, 8.6)
CLS Fitmore 49 775 2.1 (1.3, 3.4) 4.2 (3.0, 6.0) 4.7 (3.4, 6.6) 6.0 (4.4, 8.2) 9.9 (7.3, 13.4)
Citation Trident (Shell)* 48 1147 1.7 (1.1, 2.7) 2.5 (1.7, 3.5) 3.2 (2.3, 4.4) 4.0 (3.0, 5.3) 5.1 (3.7, 7.0)
Citation Vitalock* 46 555 0.5 (0.2, 1.7) 2.2 (1.2, 3.8) 2.8 (1.7, 4.5) 6.7 (4.8, 9.3) 11.6 (8.5, 15.6)
Corail ASRMoM* 1205 2901 2.2 (1.7, 2.8) 11.1 (10.0, 12.4) 26.9 (25.3, 28.6) 45.6 (43.6, 47.7)
Corail DeltaMotion 21 1046 1.1 (0.6, 2.0) 1.8 (1.1, 2.9) 2.8 (1.7, 4.7)
Corail Duraloc* 78 1433 1.4 (0.9, 2.2) 2.3 (1.6, 3.2) 3.0 (2.2, 4.0) 6.2 (4.8, 7.9)
Corail Pinnacle 1082 37501 1.8 (1.6, 1.9) 2.7 (2.5, 2.8) 3.3 (3.1, 3.5) 5.3 (4.8, 5.9)
Corail Pinnacle MoM
* 102 966 2.2 (1.4, 3.3) 3.7 (2.6, 5.1) 5.9 (4.6, 7.6) 12.9 (10.5, 15.9)
Epoch Trilogy* 43 1021 2.5 (1.7, 3.6) 3.4 (2.4, 4.7) 3.7 (2.7, 5.0) 4.2 (3.2, 5.7)
F2L SPH-Blind* 56 615 3.1 (2.0, 4.8) 4.9 (3.5, 7.0) 6.1 (4.5, 8.3) 7.6 (5.7, 10.0) 11.3 (8.5, 15.1)
H-Max Delta-TT 27 1039 1.6 (1.0, 2.6) 3.0 (2.0, 4.3) 3.3 (2.2, 5.0)
M/L Taper Allofit 17 684 1.9 (1.1, 3.3) 2.3 (1.3, 3.8) 2.5 (1.5, 4.2)
M/L Taper Continuum 33 1141 2.2 (1.5, 3.2) 3.0 (2.1, 4.3) 3.4 (2.4, 4.9)
M/L Taper Trilogy 24 769 1.4 (0.8, 2.6) 1.8 (1.0, 3.0) 3.2 (2.1, 5.0) 4.4 (2.9, 6.7)
M/L Taper
Continuum 60 2046 1.9 (1.4, 2.6) 2.9 (2.3, 3.8) 3.3 (2.6, 4.3)
Kinectiv
Mallory- Mallory-
169 2970 1.8 (1.4, 2.4) 2.3 (1.8, 2.9) 3.1 (2.5, 3.8) 5.1 (4.3, 6.1) 10.6 (8.8, 12.7) 11.0 (9.1, 13.2)
Head Head
Metafix Trinity 43 2147 1.9 (1.4, 2.6) 2.4 (1.8, 3.2) 2.4 (1.8, 3.2)
MiniHip Trinity 17 683 2.3 (1.4, 3.8) 2.7 (1.7, 4.3)
Nanos R3 7 657 0.8 (0.3, 1.8) 1.1 (0.5, 2.3) 1.1 (0.5, 2.3)
Natural Hip Fitmore* 40 889 1.0 (0.5, 1.9) 1.6 (0.9, 2.7) 2.4 (1.6, 3.7) 4.7 (3.4, 6.4) 5.4 (3.9, 7.4)
Omnifit Secur-Fit* 62 508 3.2 (1.9, 5.1) 5.0 (3.4, 7.3) 6.6 (4.7, 9.2) 10.8 (8.3, 14.0) 14.8 (11.5, 18.9)
Omnifit Trident (Shell) 76 1280 1.9 (1.3, 2.8) 3.2 (2.3, 4.3) 4.0 (3.1, 5.3) 5.5 (4.3, 7.0) 8.2 (6.4, 10.6)
Origin Logical G 7 583 1.3 (0.6, 2.8)

Acetabular
Paragon 7 744 0.7 (0.3, 1.6)
Shell (Global)
Polarstem EP-Fit Plus 3 1029 0.3 (0.1, 0.9) 0.3 (0.1, 0.9)
Polarstem R3 129 5821 1.8 (1.5, 2.2) 2.5 (2.1, 3.0) 2.9 (2.4, 3.5)
Profemur L Dynasty 22 770 3.1 (2.0, 4.7)
Quadra-H Mpact 27 1476 1.6 (1.0, 2.5) 2.6 (1.6, 4.0) 3.4 (2.1, 5.6)
Quadra-H Trident (Shell) 11 564 1.3 (0.6, 2.7) 2.3 (1.2, 4.5) 2.8 (1.5, 5.3)
Quadra-H Versafitcup CC 325 12882 1.8 (1.6, 2.0) 2.6 (2.3, 2.9) 3.0 (2.7, 3.4)
Duraloc
S-Rom 33 666 1.5 (0.8, 2.8) 2.4 (1.5, 3.9) 3.4 (2.2, 5.0) 4.7 (3.3, 6.6) 5.3 (3.8, 7.5)
Option*
S-Rom Pinnacle 146 3181 2.3 (1.9, 2.9) 3.6 (3.0, 4.4) 4.2 (3.5, 5.0) 6.0 (5.0, 7.1)
SL-Plus EP-Fit Plus 110 2288 1.7 (1.2, 2.3) 2.7 (2.1, 3.5) 3.5 (2.8, 4.3) 5.5 (4.5, 6.6)
SL-Plus R3 61 1565 2.1 (1.5, 2.9) 3.6 (2.7, 4.7) 3.9 (3.0, 5.1)
Secur-Fit DeltaMotion 21 761 0.7 (0.3, 1.6) 2.1 (1.3, 3.4) 2.5 (1.6, 4.0)
Secur-Fit Trident (Shell) 333 9228 1.7 (1.4, 2.0) 2.7 (2.4, 3.1) 3.3 (3.0, 3.7) 4.4 (3.9, 5.0) 5.6 (4.8, 6.6)
Secur-Fit
Trident (Shell) 181 5778 1.2 (1.0, 1.5) 1.9 (1.6, 2.3) 2.3 (2.0, 2.8) 3.4 (2.9, 4.0) 4.6 (3.8, 5.6) 4.6 (3.8, 5.6)
Plus
Summit ASRMoM* 456 1118 1.2 (0.7, 2.0) 6.5 (5.2, 8.1) 19.7 (17.5, 22.2) 43.9 (40.7, 47.1)
Summit Pinnacle 97 4377 1.2 (0.9, 1.6) 1.9 (1.5, 2.3) 2.1 (1.7, 2.6) 3.1 (2.4, 4.0)
Summit Pinnacle MoM
* 62 784 1.5 (0.9, 2.7) 2.2 (1.4, 3.5) 3.4 (2.3, 4.9) 8.8 (6.8, 11.2)
Synergy BHRMoM* 85 819 1.6 (0.9, 2.7) 3.1 (2.1, 4.5) 4.8 (3.6, 6.6) 12.4 (10.0, 15.3)
Synergy R3 104 4266 1.6 (1.3, 2.1) 2.3 (1.8, 2.8) 2.7 (2.2, 3.2)
Reflection
Synergy 336 7922 1.6 (1.3, 1.9) 2.4 (2.1, 2.8) 2.7 (2.4, 3.1) 4.0 (3.6, 4.5) 6.6 (5.7, 7.6) 6.6 (5.7, 7.6)
(Shell)
Taperloc Exceed 55 2203 1.5 (1.0, 2.1) 2.4 (1.8, 3.1) 2.6 (2.0, 3.4)
Taperloc G7 20 911 2.4 (1.5, 3.7)
Taperloc M2aMoM* 58 512 1.8 (0.9, 3.4) 4.4 (2.9, 6.5) 7.4 (5.4, 10.1) 12.2 (9.5, 15.6)
Taperloc Mallory-Head 71 1779 1.9 (1.3, 2.7) 2.6 (2.0, 3.5) 3.1 (2.3, 4.1) 5.2 (4.0, 6.8)
Taperloc Recap MoM
* 47 500 2.4 (1.4, 4.2) 4.3 (2.8, 6.5) 6.2 (4.4, 8.8) 10.9 (8.2, 14.4)
Taperloc Regenerex 13 571 1.6 (0.8, 3.1) 2.3 (1.3, 4.0) 2.7 (1.5, 4.7)
Trabecular
Continuum 42 680 5.0 (3.6, 7.0) 6.1 (4.5, 8.2) 6.3 (4.6, 8.4)
Metal
Tri-Fit TS Trinity 22 2059 1.1 (0.7, 1.7) 1.2 (0.8, 1.8)
Tri-Lock DeltaMotion 8 801 0.6 (0.3, 1.5) 0.8 (0.3, 1.7) 1.2 (0.6, 2.4)
Tri-Lock Pinnacle 14 675 1.5 (0.8, 2.8) 2.4 (1.4, 4.0) 2.4 (1.4, 4.0)
VerSys Trilogy 212 4423 2.5 (2.1, 3.0) 3.3 (2.8, 3.9) 3.8 (3.3, 4.4) 4.9 (4.3, 5.6) 6.0 (5.1, 7.1)
twinSys RM Cup 27 884 2.6 (1.7, 3.9) 3.3 (2.2, 4.9)
Other
2876 43320 2.3 (2.2, 2.4) 3.9 (3.7, 4.1) 5.4 (5.2, 5.6) 9.4 (9.0, 9.7) 13.1 (12.4, 13.8) 14.0 (12.9, 15.1)
(1356)
TOTAL 11205 229494
MoM
denotes metal/metal prostheses with head size larger than 32mm

a o a .o rg.au 89
Table HT13 Cumulative Percent Revision of Primary Total Conventional Hip Replacement with Hybrid Fixation
C-Stem Duraloc* 78 981 2.4 (1.6, 3.5) 3.1 (2.2, 4.4) 4.0 (2.9, 5.5) 7.3 (5.7, 9.4) 12.3 (9.4, 15.9)
C-Stem Pinnacle 27 840 1.7 (1.0, 2.9) 2.3 (1.4, 3.6) 2.8 (1.8, 4.3) 4.3 (2.8, 6.4)
C-Stem AMT Pinnacle 44 2267 1.0 (0.7, 1.5) 2.1 (1.5, 3.0) 2.7 (2.0, 3.8)
CPCS R3 112 3905 2.1 (1.7, 2.6) 2.9 (2.4, 3.6) 3.4 (2.8, 4.2)
Reflection
CPCS 86 2985 0.9 (0.6, 1.3) 1.3 (0.9, 1.7) 1.7 (1.3, 2.2) 4.0 (3.1, 5.0)
(Shell)
CPT Allofit 27 1138 1.2 (0.7, 2.0) 1.7 (1.1, 2.7) 3.0 (2.0, 4.4) 3.4 (2.2, 5.2)
CPT Continuum 97 2521 2.9 (2.3, 3.7) 3.9 (3.2, 4.8) 4.5 (3.7, 5.6)
Trabecular
CPT 76 1612 2.5 (1.8, 3.4) 3.8 (2.9, 5.0) 5.0 (3.9, 6.4) 7.3 (5.6, 9.5)
Metal (Shell)
CPT Trilogy 295 7786 1.8 (1.5, 2.1) 2.7 (2.3, 3.1) 3.5 (3.0, 3.9) 5.1 (4.5, 5.8) 6.4 (5.4, 7.4)
E2 C2 11 521 1.4 (0.7, 2.9) 1.9 (1.0, 3.7) 3.3 (1.6, 6.6)
Elite Plus Duraloc* 116 1078 2.0 (1.3, 3.0) 3.6 (2.7, 5.0) 5.4 (4.2, 7.0) 9.7 (7.9, 11.8) 15.8 (13.0, 19.2)
Evolve Logical G 4 653 0.7 (0.3, 1.8)
Exeter Vitalock* 69 1218 1.6 (1.0, 2.5) 2.3 (1.6, 3.4) 2.5 (1.8, 3.6) 4.8 (3.6, 6.2) 6.9 (5.5, 8.8) 7.3 (5.7, 9.4)
Exeter V40 ABGII 42 1093 1.1 (0.6, 1.9) 1.4 (0.8, 2.3) 2.0 (1.3, 3.1) 3.6 (2.6, 5.0) 5.2 (3.8, 7.1)
Exeter V40 Fixa 13 590 1.9 (1.0, 3.4) 2.4 (1.4, 4.1)
Exeter V40 Hemispherical 27 709 2.1 (1.3, 3.5) 3.2 (2.1, 4.8) 3.3 (2.2, 5.0) 5.1 (3.3, 7.7)
Exeter V40 Mallory-Head 36 1413 0.6 (0.3, 1.2) 1.0 (0.6, 1.7) 1.1 (0.7, 1.9) 3.0 (2.1, 4.4)
Exeter V40 Pinnacle 43 1625 1.6 (1.1, 2.4) 2.3 (1.7, 3.2) 2.7 (2.0, 3.8) 6.0 (3.3, 10.9)
Exeter V40 R3 47 1765 1.4 (0.9, 2.1) 2.5 (1.8, 3.4) 3.4 (2.5, 4.6)
Exeter V40 Trident (Shell) 1344 52552 1.2 (1.1, 1.3) 1.9 (1.8, 2.0) 2.5 (2.3, 2.6) 4.1 (3.8, 4.4) 5.7 (5.0, 6.5)
Trident/
Exeter V40 Tritanium 67 3314 1.5 (1.1, 1.9) 2.1 (1.6, 2.7) 2.7 (2.1, 3.6)
(Shell)
Exeter V40 Trilogy* 20 605 1.7 (0.9, 3.1) 2.4 (1.4, 4.0) 2.6 (1.6, 4.2) 4.0 (2.5, 6.5)
Exeter V40 Vitalock* 76 1959 0.9 (0.6, 1.5) 1.7 (1.2, 2.3) 2.3 (1.7, 3.1) 3.4 (2.7, 4.4) 4.9 (3.9, 6.2)
MS 30 Allofit 53 1568 1.2 (0.7, 1.8) 1.7 (1.2, 2.5) 2.2 (1.6, 3.2) 3.9 (2.8, 5.2)
MS 30 Fitmore 21 662 0.5 (0.1, 1.4) 1.0 (0.5, 2.3) 1.5 (0.7, 3.0) 3.0 (1.7, 5.2) 6.4 (3.9, 10.4)
Omnifit Trident (Shell) 90 2764 1.8 (1.4, 2.4) 2.8 (2.2, 3.5) 3.1 (2.5, 3.8) 3.6 (2.9, 4.5) 4.7 (3.5, 6.3)
Versafitcup
Quadra-C 22 924 2.2 (1.4, 3.4) 2.4 (1.5, 3.7) 3.2 (1.8, 5.6)
CC
Spectron EF BHRMoM* 58 532 0.8 (0.3, 2.0) 2.9 (1.8, 4.8) 6.3 (4.5, 8.8) 14.3 (11.0, 18.6)
Spectron EF R3 46 1676 1.5 (1.0, 2.2) 2.4 (1.8, 3.4) 3.0 (2.2, 4.1)
Reflection
Spectron EF 278 5149 1.1 (0.8, 1.4) 1.9 (1.6, 2.4) 2.7 (2.3, 3.2) 5.7 (5.0, 6.5) 10.9 (9.4, 12.8) 13.3 (10.7, 16.5)
(Shell)
Taper Fit Trinity 10 577 1.6 (0.8, 3.1) 1.9 (1.0, 3.7)
Other (915) 1057 18086 1.8 (1.6, 2.0) 3.1 (2.9, 3.4) 4.4 (4.1, 4.8) 7.9 (7.4, 8.5) 11.3 (10.5, 12.2) 11.6 (10.7, 12.6)
TOTAL 4392 125068
MoM
denotes metal/metal prostheses with head size larger than 32mm

OUTCOME FOR OSTEOARTHRITIS - PATIENT CHARACTERISTICS

The following analyses have been undertaken Type of Revision
excluding all procedures using large head
The five most common types of revision are:
metal/metal bearing surface. The 16 year
femoral only (32.7%), acetabular only (21.6%),
cumulative percent revision of primary total
head and insert (19.7%), total hip replacement
conventional hip replacement undertaken for
(femoral/acetabular) (11.9%) and head only
osteoarthritis is 8.8% (Table HT14 and Figure HT5).
(4.9%) (Table HT16).
Reason for Revision
Age and Gender
The most common reasons for revision of
There is a difference in the rate of revision with
primary total conventional hip replacement
respect to age and this varies with time. After
are: loosening (25.6%), prosthesis dislocation
two years, patients aged 75 years or older have
(21.6%), fracture (19.5%), and infection (17.7%)
a lower rate of revision than all other age
(Table HT15).
groups (Table HT17 and Figure HT7).
The most common reason for revision varies
Males have a higher rate of revision after 1.5
with time. In the first six years, dislocation is the
years. The cumulative percent revision at 16
most frequent reason for revision. After seven
years is 9.2% for males and 8.4% for females
years, loosening is the predominant reason for
(Table HT18 and Figure HT8). The Registry
revision (Figure HT6).
continues to report a difference in the rate of
revision between age groups within gender.
The aetiology of loosening changes with time.
Males aged 75 years or older have a higher
Loosening reported in the first few years most
rate of revision initially, compared to the
likely reflects failure to gain fixation. Loosening
younger age groups. However, this difference is
reported in later years is often due to loss of
no longer evident as time progresses (Table
fixation secondary to bone resorption.
HT18 and Figure HT9).
Previously, the Registry has reported
For females, the rate of revision decreases with
loosening/lysis as a single diagnosis. This
increasing age. After three months, females
included the diagnoses of loosening or lysis, as
aged less than 55 years have almost twice the
well as loosening and lysis combined. Loosening
rate of revision compared to females aged 75
and lysis are now reported separately. The
years or older (Table HT18 and Figure HT10).
diagnosis of loosening is used when loosening is
reported either alone or in combination with
lysis. The diagnosis of lysis is used for procedures
that report only this diagnosis.

a o a .o rg.au 91
Table HT14 Cumulative Percent Revision of Primary Total Conventional Hip Replacement (Primary Diagnosis OA)
N N
Revised Total
TOTAL 11610 324627
Figure HT5 Cumulative Percent Revision of Primary Total Conventional Hip Replacement (Primary Diagnosis OA)
24%
Total Conventional
22%
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Total Conventional 324627 285535 219001 162111 61303 6575 1649

Table HT15 Primary Total Conventional Hip Replacement Table HT16 Primary Total Conventional Hip Replacement by
by Reason for Revision (Primary Diagnosis Type of Revision (Primary Diagnosis OA)
OA)

Loosening 2975 25.6 Femoral Component 3801 32.7
Prosthesis Dislocation 2506 21.6 Acetabular Component 2511 21.6
Fracture 2265 19.5 Head/Insert 2284 19.7
Leg Length Discrepancy 169 1.5 Minor Components 209 1.8
Malposition 154 1.3 Insert Only 138 1.2
Instability 125 1.1 Removal of Prostheses 69 0.6
Implant Breakage Stem 119 1.0 Head/Neck/Insert 64 0.6
Metal Related Pathology 118 1.0 Head/Neck 49 0.4
Implant Breakage Reinsertion of Components 10 0.1
102 0.9
Acetabular Insert Neck Only 5 0.0
Wear Acetabular Insert 98 0.8 Bipolar Only 3 0.0
Incorrect Sizing 90 0.8 Total Femoral 2 0.0
Implant Breakage Neck/Insert 1 0.0
76 0.7
Acetabular
Saddle 1 0.0
Implant Breakage Head 39 0.3
Bipolar Head and Femoral 1 0.0
Other 234 2.0
TOTAL 11610 100.0
TOTAL 11610 100.0
Note: All procedures using metal/metal prostheses with head size Note: All procedures using metal/metal prostheses with head size
larger than 32mm have been excluded larger than 32mm have been excluded
Femoral heads are usually replaced when the acetabular
component and/or femoral stem is revised.
Figure HT6 Cumulative Incidence Revision DiagnosisTotal

of Primary Total Conventional Hip Replacement (Primary Diagnosis OA)
Conventional
5.0%
Loosening
Prosthesis Dislocation
Fracture
4.0% Infection
Lysis
3.0%
2.0%
1.0%
0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

a o a .o rg.au 93
Table HT17 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Age (Primary Diagnosis OA)
N N
Revised Total
<55 1437 34607 1.5 (1.3, 1.6) 2.6 (2.4, 2.7) 3.5 (3.2, 3.7) 5.8 (5.5, 6.2) 9.9 (9.2, 10.7) 10.4 (9.5, 11.3)
55-64 2912 77367 1.5 (1.4, 1.5) 2.3 (2.2, 2.5) 3.0 (2.9, 3.2) 5.4 (5.2, 5.6) 8.7 (8.2, 9.1) 9.8 (9.0, 10.7)
65-74 4085 115632 1.5 (1.4, 1.5) 2.3 (2.2, 2.4) 3.0 (2.9, 3.1) 4.9 (4.7, 5.1) 7.8 (7.4, 8.2) 8.2 (7.7, 8.7)
≥75 3176 97021 1.7 (1.6, 1.8) 2.5 (2.4, 2.6) 3.1 (3.0, 3.2) 4.8 (4.6, 5.0) 6.4 (6.0, 6.9) 6.8 (6.1, 7.6)
TOTAL 11610 324627
Figure HT7 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Age (Primary Diagnosis OA)
24% <55 vs ≥75
<55
0 - 2Wk: HR=1.00 (0.81, 1.23),p=0.971
22% 55-64
65-74 2Wk - 3Mth: HR=0.61 (0.53, 0.72),p<0.001
20% ≥75 3Mth - 9Mth: HR=1.06 (0.89, 1.28),p=0.504
9Mth - 1.5Yr: HR=1.42 (1.18, 1.71),p<0.001
18%
1.5Yr - 5.5Yr: HR=1.45 (1.30, 1.62),p<0.001
16% 5.5Yr - 7.5Yr: HR=1.26 (1.02, 1.54),p=0.029

7.5Yr+: HR=1.63 (1.42, 1.87),p<0.001
14%
55-64 vs ≥75
12% 0 - 3Mth: HR=0.73 (0.66, 0.80),p<0.001
3Mth - 6Mth: HR=0.83 (0.69, 1.00),p=0.056
10%
6Mth - 9Mth: HR=1.30 (1.05, 1.59),p=0.014
8% 9Mth - 1.5Yr: HR=1.24 (1.07, 1.45),p=0.004
6% 1.5Yr - 2Yr: HR=1.03 (0.83, 1.27),p=0.819

2Yr - 7Yr: HR=1.18 (1.08, 1.29),p<0.001
4%
7Yr+: HR=1.42 (1.28, 1.58),p<0.001
2% 65-74 vs≥ 75
0 - 6Mth: HR=0.79 (0.73, 0.85),p<0.001
0%
6Mth - 1.5Yr: HR=1.17 (1.03, 1.32),p=0.012
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1.5Yr - 2Yr: HR=1.00 (0.82, 1.21),p=0.989
2Yr+: HR=1.14 (1.06, 1.23),p<0.001

<55 34607 30486 23056 16938 7220 1086 294
55-64 77367 68303 53041 40079 16448 2165 581
65-74 115632 101898 78673 59021 23965 2516 614
≥75 97021 84848 64231 46073 13670 808 160

Table HT18 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Gender and Age (Primary
Diagnosis OA)
N N
Gender Age 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Male 5500 148490 1.6 (1.5, 1.6) 2.5 (2.4, 2.6) 3.2 (3.1, 3.3) 5.5 (5.3, 5.6) 8.6 (8.2, 8.9) 9.2 (8.6, 9.7)
<55 721 18942 1.3 (1.2, 1.5) 2.4 (2.1, 2.6) 3.2 (3.0, 3.6) 5.5 (5.0, 6.0) 9.2 (8.3, 10.2) 9.5 (8.5, 10.6)
55-64 1456 38297 1.5 (1.4, 1.6) 2.4 (2.2, 2.5) 3.1 (2.9, 3.3) 5.5 (5.1, 5.8) 9.0 (8.3, 9.7) 10.1 (9.0, 11.4)
65-74 1916 53264 1.4 (1.3, 1.5) 2.3 (2.2, 2.5) 3.1 (2.9, 3.2) 5.2 (4.9, 5.5) 8.1 (7.5, 8.7) 8.3 (7.7, 9.1)
≥75 1407 37987 1.9 (1.8, 2.1) 2.9 (2.7, 3.1) 3.6 (3.4, 3.9) 5.8 (5.5, 6.2) 7.4 (6.8, 8.2)
Female 6110 176137 1.5 (1.5, 1.6) 2.3 (2.3, 2.4) 3.0 (2.9, 3.1) 4.8 (4.7, 5.0) 7.7 (7.4, 8.0) 8.4 (7.9, 9.0)
<55 716 15665 1.6 (1.4, 1.8) 2.8 (2.5, 3.1) 3.7 (3.4, 4.0) 6.3 (5.8, 6.8) 10.8 (9.7, 12.0) 11.4 (9.8, 13.2)
55-64 1456 39070 1.4 (1.3, 1.5) 2.3 (2.2, 2.5) 3.0 (2.8, 3.2) 5.3 (5.0, 5.6) 8.4 (7.7, 9.0) 9.5 (8.4, 10.8)
65-74 2169 62368 1.5 (1.4, 1.6) 2.3 (2.2, 2.5) 3.0 (2.8, 3.1) 4.6 (4.4, 4.9) 7.5 (7.0, 8.1) 8.0 (7.4, 8.7)
≥75 1769 59034 1.6 (1.5, 1.7) 2.2 (2.1, 2.4) 2.8 (2.7, 2.9) 4.2 (4.0, 4.5) 5.9 (5.4, 6.4) 6.4 (5.5, 7.4)
TOTAL 11610 324627
Figure HT8 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Gender (Primary Diagnosis OA)

24%
Male
Male vs Female
22% Female
0 - 1.5Yr: HR=1.00 (0.95, 1.05),p=0.973
20% 1.5Yr+: HR=1.18 (1.12, 1.24),p<0.001
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Male 148490 129963 98290 71737 26937 3079 760
Female 176137 155572 120711 90374 34366 3496 889

a o a .o rg.au 95
Figure HT9 Cumulative Percent Revision of Primary Total Conventional Hip Replacement in Males by Age (Primary Diagnosis
OA)
Male<55 vs Male≥75
0 - 2Wk: HR=1.00 (0.75, 1.35),p=0.983
24%
Male <55 2Wk - 1Mth: HR=0.52 (0.38, 0.70),p<0.001
22% Male 55-64 1Mth - 3Mth: HR=0.57 (0.43, 0.77),p<0.001
Male 65-74 3Mth - 1.5Yr: HR=0.85 (0.70, 1.03),p=0.105
20% Male ≥75
1.5Yr - 5.5Yr: HR=1.17 (1.00, 1.37),p=0.043
18% 5.5Yr - 7.5Yr: HR=0.82 (0.60, 1.13),p=0.226
7.5Yr+: HR=1.23 (1.01, 1.50),p=0.039

16%
Male 55-64 vs Male ≥75
14% 0 - 2Wk: HR=0.83 (0.65, 1.06),p=0.131
2Wk - 1Mth: HR=0.65 (0.53, 0.81),p<0.001
12%
1Mth - 9Mth: HR=0.77 (0.66, 0.89),p<0.001
10% 9Mth - 2Yr: HR=0.92 (0.78, 1.09),p=0.361
8% 2Yr - 3.5Yr: HR=1.01 (0.84, 1.22),p=0.881

3.5Yr - 7Yr: HR=0.95 (0.81, 1.11),p=0.528
6% 7Yr - 11Yr: HR=1.10 (0.92, 1.31),p=0.317
4% 11Yr+: HR=1.36 (1.07, 1.73),p=0.011

2%
0 - 3Mth: HR=0.70 (0.62, 0.79),p<0.001
0% 3Mth - 6Mth: HR=0.69 (0.54, 0.89),p=0.004
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 6Mth - 1.5Yr: HR=0.89 (0.76, 1.04),p=0.153
Years Since Primary Procedure 1.5Yr+: HR=0.98 (0.89, 1.08),p=0.728

Male <55 18942 16614 12366 8892 3821 630 179
55-64 38297 33589 25777 19233 8003 1116 277
65-74 53264 47000 36193 26983 10762 1120 267
≥75 37987 32760 23954 16629 4351 213 37
Figure HT10 Cumulative Percent Revision of Primary Total Conventional Hip Replacement in Females by Age (Primary
Diagnosis OA)
24%
Female <55
Female <55 vs Female ≥75
22% Female 55-64
Female 65-74 0 - 2Wk: HR=1.04 (0.77, 1.41),p=0.809
20% Female ≥75 2Wk - 3Mth: HR=0.69 (0.56, 0.86),p=0.001
3Mth+: HR=1.80 (1.63, 1.99),p<0.001
18%
16% Female 55-64 vs Female ≥75

0 - 3Mth: HR=0.73 (0.64, 0.83),p<0.001
14%
3Mth - 6Mth: HR=1.13 (0.88, 1.45),p=0.332
12% 6Mth+: HR=1.43 (1.31, 1.56),p<0.001
10% Female 65-74 vs Female ≥75

8% 0 - 3Mth: HR=0.87 (0.78, 0.97),p=0.011
3Mth+: HR=1.23 (1.14, 1.33),p<0.001

6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Female <55 15665 13872 10690 8046 3399 456 115
55-64 39070 34714 27264 20846 8445 1049 304
65-74 62368 54898 42480 32038 13203 1396 347
≥75 59034 52088 40277 29444 9319 595 123

OUTCOME FOR OSTEOARTHRITIS - PROSTHESIS CHARACTERISTICS

These analyses have been undertaken for total conventional hip replacement using a
excluding all procedures using large head mini stem is 6.2% compared to 5.1% for other
metal/metal bearing surface. femoral stems. There is no difference in the
overall rate of revision when a mini stem is used
Fixation
(Table HT21 and Figure HT16). The cumulative
This year the Registry has performed an analysis incidence of loosening for procedures using a
of the effect of fixation, to reflect the modern mini stem is over twice that of other femoral
use of bearing surfaces. This analysis is restricted stems at 10 years (2.7% compared to 1.3%)
to ceramic/ceramic and all femoral head (Figure HT17). The types of revision are
materials used in combination with XLPE. presented in Table HT22.
Metal/metal, ceramic/metal, metal/ceramic,
and non XLPE have been excluded. Modern The Registry has information on 11 different mini
bearing surfaces account for 97.3% of all stem prostheses. Rates of revision vary
primary total conventional hip procedures depending on the type of prosthesis (Table
performed in 2016. HT23).
Femoral Stems with Exchangeable Necks
The outcome with respect to fixation varies A femoral stem with an exchangeable neck
with age. has a separate neck that connects proximally
to the stem. Femoral stems with exchangeable
necks were introduced to enable surgeons to
have increased choice with respect to
There is no difference in the rate of revision for determining femoral neck version, offset and
cemented compared to hybrid fixation. length during total conventional hip
Cementless fixation has a higher rate of revision replacement.
than hybrid fixation. Cementless fixation has a
higher rate of revision than cemented fixation The Registry has recorded 10,114 procedures
for the first 1.5 years and after this time there is using femoral stems with exchangeable necks
no difference (Table HT19 and Figure HT11). undertaken for osteoarthritis. There were 355
procedures reported in 2016, a 23.0% decrease
For patients aged less than 55 years and 55 to compared to 2015. The proportion of
64 years, there is no difference in the rate of procedures using exchangeable necks peaked
revision when comparing fixation methods. The in 2010 at 6.6% of all primary total conventional
exception is a higher rate of revision in the first hip procedures. This proportion continues to
month for cementless fixation compared to decrease, with 1.1% of all procedures using a
hybrid fixation in patients aged 55 to 64 years. stem with an exchangeable neck in 2016.
Cementless fixation has a higher rate of revision
compared to hybrid fixation for all patients Femoral stems with exchangeable necks have
aged 65 years or older, and when compared to almost twice the rate of revision compared to
cemented fixation for patients aged 75 years or fixed neck stems. The cumulative percent
older (Table HT20 and Figures HT12 to HT15). revision at 15 years is 12.0% for stems with
exchangeable necks compared to 7.9% for
fixed neck stems (Table HT24 and Figure HT18).
Mini Stems
The increase in the rate of revision is due to a
The Registry defines a mini stem as a short higher cumulative incidence of loosening (2.5%
cementless femoral stem where fixation is at 15 years compared to 1.9% for fixed femoral
designed to be entirely metaphyseal. These neck), dislocation (1.8% compared to 1.1%)
stems may enable femoral neck sparing. and fracture (2.3% compared to 1.3%) (Figure
HT19).
There have been 2,877 procedures using a mini
stem prosthesis undertaken for osteoarthritis. This Of the revisions of femoral stems with
represents less than 1.0% of all total exchangeable necks, 2.9% are for implant
conventional hip procedures. There were 597 breakage of the femoral component
procedures recorded in 2016 using a mini stem compared to 0.9% for fixed neck stems (Table
prosthesis; an increase of 33.9% compared to HT25). The higher rate of revision when using
2015. The 10 year cumulative percent revision

a o a .o rg.au 97
stems with exchangeable necks is evident for The reason for this difference is a higher
all bearing surfaces (Figure HT20). cumulative incidence for each of the five main
reasons for revision, with the exception of
The Registry has previously identified that the infection. At 10 years, the cumulative incidence
stem/neck metal combination has an effect on of metal related pathology is 3.6% for
the rate of revision. There are five different titanium/cobalt chrome compared to 0.2% for
stem/neck metal combinations. Only the two titanium/titanium (Figure HT22).
principal combinations are included in
comparative analysis. These are titanium The Registry has information on 14 different
stem/titanium neck and titanium stem/cobalt exchangeable femoral neck prostheses that
chrome neck. The titanium/cobalt chrome have been used in more than 60 procedures.
combination has a higher rate of revision The outcomes of each of these stems are
compared to the titanium/titanium detailed in Table HT27.
combination (Table HT26 and Figure HT21).
Table HT19 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Fixation (Primary Diagnosis OA)
N N
Fixation 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Cemented 121 5130 1.4 (1.1, 1.8) 2.1 (1.7, 2.6) 2.7 (2.2, 3.3) 3.7 (2.9, 4.7)
Cementless 5955 179366 1.7 (1.7, 1.8) 2.6 (2.5, 2.7) 3.3 (3.2, 3.4) 4.9 (4.8, 5.1) 6.9 (6.5, 7.2) 7.0 (6.6, 7.4)
Hybrid 2383 93309 1.2 (1.1, 1.3) 1.9 (1.8, 2.0) 2.5 (2.4, 2.6) 3.9 (3.7, 4.1) 5.8 (5.2, 6.4) 6.0 (5.3, 6.9)
TOTAL 8459 277805
Note: Includes procedures using ceramic/ceramic and XLPE prostheses
Figure HT11 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Fixation (Primary Diagnosis OA)

24%
Cemented Cemented vs Hybrid
22% Cementless
Hybrid
20%
Cementless vs Hybrid
18% 0 - 2Wk: HR=2.10 (1.75, 2.51),p<0.001
2Wk - 1Mth: HR=1.47 (1.28, 1.69),p<0.001

16%
1Mth - 3Mth: HR=1.28 (1.12, 1.46),p<0.001
14% 3Mth - 1.5Yr: HR=1.35 (1.23, 1.50),p<0.001
12% 1.5Yr+: HR=1.20 (1.12, 1.29),p<0.001
10% Cementless vs Cemented

0 - 2Wk: HR=1.95 (1.52, 2.50),p<0.001
8%
2Wk - 1.5Yr: HR=1.27 (1.05, 1.53),p=0.013
6% 1.5Yr+: HR=1.12 (0.92, 1.35),p=0.252
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Cemented 5130 4430 2882 1542 343 3 1
Cementless 179366 155056 114408 79927 24810 1605 288
Hybrid 93309 81380 60725 43554 13186 605 68

Table HT20 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Age and Fixation (Primary
Diagnosis OA)
N N
Age Fixation 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
<55 1087 31201 1.5 (1.4, 1.6) 2.6 (2.4, 2.8) 3.4 (3.2, 3.7) 5.3 (4.9, 5.7) 7.3 (6.6, 8.0) 7.3 (6.6, 8.0)
Cemented 5 209 1.5 (0.5, 4.4) 2.0 (0.8, 5.2) 2.8 (1.1, 6.6)
Cementless 919 25741 1.5 (1.4, 1.7) 2.7 (2.5, 2.9) 3.5 (3.3, 3.8) 5.3 (5.0, 5.8) 7.2 (6.5, 8.1) 7.2 (6.5, 8.1)
Hybrid 163 5251 1.3 (1.0, 1.6) 2.0 (1.7, 2.5) 2.9 (2.4, 3.5) 5.2 (4.3, 6.2) 7.5 (5.9, 9.7)
55-64 2135 68842 1.5 (1.4, 1.6) 2.3 (2.1, 2.4) 2.9 (2.7, 3.0) 4.7 (4.5, 4.9) 6.6 (6.1, 7.1) 6.7 (6.1, 7.3)
Cemented 24 644 2.4 (1.5, 4.0) 3.7 (2.4, 5.6) 3.7 (2.4, 5.6) 4.8 (2.7, 8.5)
Cementless 1662 52487 1.5 (1.4, 1.7) 2.4 (2.2, 2.5) 3.0 (2.8, 3.2) 4.7 (4.5, 5.0) 6.4 (5.9, 7.0) 6.6 (6.0, 7.2)
Hybrid 449 15711 1.1 (1.0, 1.3) 1.8 (1.6, 2.0) 2.5 (2.2, 2.8) 4.5 (4.0, 5.0) 7.0 (5.7, 8.4)
65-74 2860 98689 1.5 (1.4, 1.5) 2.3 (2.2, 2.4) 2.9 (2.7, 3.0) 4.3 (4.1, 4.4) 6.2 (5.7, 6.7) 6.5 (5.9, 7.3)
Cemented 41 1672 1.2 (0.8, 1.9) 1.9 (1.4, 2.8) 2.7 (1.9, 3.8) 4.6 (3.0, 6.9)
Cementless 1982 63823 1.6 (1.5, 1.7) 2.5 (2.4, 2.6) 3.1 (3.0, 3.3) 4.5 (4.3, 4.8) 6.5 (5.9, 7.1) 6.7 (6.0, 7.5)
Hybrid 837 33194 1.1 (1.0, 1.2) 1.8 (1.7, 2.0) 2.4 (2.2, 2.6) 3.7 (3.5, 4.0) 5.6 (4.8, 6.6)
≥75 2377 79073 1.7 (1.7, 1.8) 2.5 (2.4, 2.6) 3.1 (2.9, 3.2) 4.6 (4.4, 4.8) 6.2 (5.5, 6.8)
Cemented 51 2605 1.2 (0.9, 1.8) 1.8 (1.3, 2.4) 2.5 (1.9, 3.4) 2.7 (2.0, 3.7)
Cementless 1392 37315 2.3 (2.1, 2.4) 3.1 (2.9, 3.3) 3.7 (3.5, 4.0) 5.8 (5.4, 6.2) 8.3 (7.1, 9.7)
Hybrid 934 39153 1.3 (1.2, 1.4) 1.9 (1.8, 2.1) 2.4 (2.3, 2.6) 3.6 (3.4, 3.9) 4.4 (3.9, 5.0)
TOTAL 8459 277805
Figure HT12 Cumulative Percent Revision of Primary Total Conventional Hip Replacement in Patients Aged <55 Years by
Fixation (Primary Diagnosis OA)

24%
22% Cementless
Hybrid
20%

12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Cemented 209 185 139 67 16 2 1
Cementless 25741 22454 16622 11718 4268 408 88
Hybrid 5251 4559 3254 2281 812 79 6

a o a .o rg.au 99
Figure HT13 Cumulative Percent Revision of Primary Total Conventional Hip Replacement in Patients Aged 55-64 Years by

24%
22% Cementless
Hybrid
20%
18% 0 - 1Mth: HR=2.13 (1.58, 2.88),p<0.001
1Mth+: HR=1.01 (0.91, 1.13),p=0.806

16%
14% Cemented vs Cementless

12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Cemented 644 572 412 236 64 0 0
Cementless 52487 45739 34419 24829 8540 667 123
Hybrid 15711 13784 10526 7760 2641 151 15
Figure HT14 Cumulative Percent Revision of Primary Total Conventional Hip Replacement in Patients Aged 65-74 Years by

24%
22% Cementless
Hybrid
20%
18% 0 - 2Wk: HR=2.51 (1.78, 3.53),p<0.001
2Wk - 3Mth: HR=1.48 (1.26, 1.75),p<0.001

16%
3Mth+: HR=1.17 (1.07, 1.29),p=0.001
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Cemented 1672 1447 949 508 145 0 0
Cementless 63823 55010 40334 28082 8604 460 73
Hybrid 33194 29173 22161 16347 5605 262 34

Figure HT15 Cumulative Percent Revision of Primary Total Conventional Hip Replacement in Patients Aged ≥75 Years by

24%
22% Cementless
Hybrid
20%
18% 0 - 3Mth: HR=1.89 (1.66, 2.16),p<0.001
3Mth+: HR=1.43 (1.28, 1.59),p<0.001

16%

12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Cemented 2605 2226 1382 731 118 1 0
Cementless 37315 31853 23033 15298 3398 70 4
Hybrid 39153 33864 24784 17166 4128 113 13

a o a .o rg.a u 101
Table HT21 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Stem Type (Primary Diagnosis OA)
N N
Stem Type 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Mini Stem 68 2877 1.6 (1.2, 2.2) 2.2 (1.7, 2.9) 2.7 (2.1, 3.7) 6.2 (4.0, 9.6)
Other Femoral Stem 11542 321750 1.5 (1.5, 1.6) 2.4 (2.4, 2.5) 3.1 (3.0, 3.2) 5.1 (5.0, 5.2) 8.1 (7.8, 8.3) 8.8 (8.4, 9.1)
TOTAL 11610 324627
Figure HT16 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Stem Type (Primary Diagnosis OA)

24%
Mini Stem
Mini Stem vs Other Femoral Stem
22% Other Femoral Stem
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Mini Stem 2877 2232 1339 576 137 3 1
Other Femoral Stem 321750 283303 217662 161535 61166 6572 1648
Figure HT17 Cumulative Incidence Revision Diagnosis of Primary Total Conventional Hip Replacement by Stem Type (Primary
Diagnosis OA)
Mini Stem Other Femoral Stem
5.0% 5.0%
Loosening Loosening
Fracture Fracture
4.0% Infection 4.0% Infection
Lysis Lysis
3.0% 3.0%
2.0% 2.0%
1.0% 1.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Table HT22 Primary Total Conventional Hip Replacement by Type of Revision and Stem Type (Primary Diagnosis OA)
Mini Stem Other Femoral Stem

% Primaries % Primaries
Type of Revision Number % Revisions Number % Revisions
Revised Revised
Femoral Component 36 1.3 52.9 3765 1.2 32.6
Acetabular Component 14 0.5 20.6 2497 0.8 21.6
Head/Insert 7 0.2 10.3 2277 0.7 19.7
THR (Femoral/Acetabular) 3 0.1 4.4 1375 0.4 11.9
Head Only 5 0.2 7.4 560 0.2 4.9
Cement Spacer 2 0.1 2.9 517 0.2 4.5
Minor Components 1 0.0 1.5 208 0.1 1.8
Insert Only 138 0.0 1.2
Removal of Prostheses 69 0.0 0.6
Head/Neck/Insert 64 0.0 0.6
Head/Neck 49 0.0 0.4
Reinsertion of Components 10 0.0 0.1
Neck Only 5 0.0 0.0
Bipolar Only 3 0.0 0.0
Total Femoral 2 0.0 0.0
Bipolar Head and Femoral 1 0.0 0.0
Neck/Insert 1 0.0 0.0
Saddle 1 0.0 0.0
N Revision 68 2.4 100.0 11542 3.6 100.0
N Primary 2877 321750
Table HT23 Cumulative Percent Revision of Primary Total Conventional Hip Replacement using a Mini Stem by Femoral Stem
N N
Femoral Component 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
C.F.P.* 10 124 4.0 (1.7, 9.4) 4.0 (1.7, 9.4) 4.9 (2.2, 10.5) 7.7 (4.1, 14.2)
Mallory-Head 5 114 2.7 (0.9, 8.1) 5.5 (2.3, 13.1)
Mayo* 7 96 2.1 (0.5, 8.1) 4.2 (1.6, 10.8) 4.2 (1.6, 10.8) 7.3 (3.3, 16.0)
Metha 5 106 2.8 (0.9, 8.6) 4.8 (2.0, 11.1)
MiniHip 19 742 2.1 (1.3, 3.5) 2.5 (1.5, 3.9) 4.7 (2.3, 9.4)
Nanos 7 664 0.8 (0.3, 1.8) 1.1 (0.5, 2.3) 1.1 (0.5, 2.3)
Optimys 1 412 0.3 (0.0, 2.0)
Silent* 3 50 4.0 (1.0, 15.1) 6.0 (2.0, 17.5) 6.0 (2.0, 17.5)
Taperloc Microplasty 8 552 1.4 (0.7, 3.0) 1.4 (0.7, 3.0) 2.2 (0.9, 4.9)
Other (2) 3 17 5.9 (0.9, 35.0) 5.9 (0.9, 35.0) 5.9 (0.9, 35.0) 29.4 (10.0, 68.5)
TOTAL 68 2877
Note: Only prostheses with over 50 procedures have been listed

* denotes prostheses with no reported use in primary total conventional hip replacement in 2016

a o a .o rg.a u 103
Table HT24 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Type of Femoral Neck (Primary
Diagnosis OA)
N N
Femoral Neck 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Exchangeable 691 10114 2.7 (2.4, 3.1) 4.5 (4.1, 4.9) 6.0 (5.6, 6.5) 9.1 (8.4, 9.9) 12.0 (10.5, 13.8)
Fixed 10919 314513 1.5 (1.5, 1.5) 2.3 (2.3, 2.4) 3.0 (2.9, 3.1) 5.0 (4.9, 5.1) 7.9 (7.7, 8.2) 8.6 (8.2, 9.0)
TOTAL 11610 324627
Figure HT18 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Type of Femoral Neck (Primary
Diagnosis OA)

24%
Exchangeable
Exchangeable vs Fixed
22% Fixed
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Exchangeable 10114 9407 8004 6117 1466 103 23
Fixed 314513 276128 210997 155994 59837 6472 1626

Figure HT19 Cumulative Incidence Revision Diagnosis of Primary Total Conventional Hip Replacement by Type of Femoral
Neck (Primary Diagnosis OA)
Exchangeable Fixed
5.0% 5.0%
Loosening Loosening
Fracture Fracture
Lysis Lysis
3.0% 3.0%
2.0% 2.0%
1.0% 1.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Table HT25 Primary Total Conventional Hip Replacement by Reason for Revision and Type of Femoral Neck (Primary Diagnosis
OA)
Exchangeable Fixed
Reason for Revision Number % Revisions Number % Revisions
Revised Revised
Loosening 179 1.8 25.9 2796 0.9 25.6
Prosthesis Dislocation 147 1.5 21.3 2359 0.8 21.6
Fracture 117 1.2 16.9 2148 0.7 19.7
Infection 75 0.7 10.9 1980 0.6 18.1
Lysis 13 0.1 1.9 253 0.1 2.3
Pain 17 0.2 2.5 202 0.1 1.8
Leg Length Discrepancy 7 0.1 1.0 162 0.1 1.5
Malposition 9 0.1 1.3 145 0.0 1.3
Instability 11 0.1 1.6 114 0.0 1.0
Implant Breakage Stem 20 0.2 2.9 99 0.0 0.9
Wear Acetabular Insert 98 0.0 0.9
Implant Breakage Acetabular
10 0.1 1.4 92 0.0 0.8
Insert
Incorrect Sizing 7 0.1 1.0 83 0.0 0.8
Implant Breakage Acetabular 11 0.1 1.6 65 0.0 0.6
Metal Related Pathology 57 0.6 8.2 61 0.0 0.6
Wear Head 2 0.0 0.3 39 0.0 0.4
Implant Breakage Head 3 0.0 0.4 36 0.0 0.3
Heterotopic Bone 18 0.0 0.2
Tumour 14 0.0 0.1
Wear Acetabulum 13 0.0 0.1
Synovitis 1 0.0 0.1 2 0.0 0.0
Other 5 0.0 0.7 140 0.0 1.3
N Revision 691 6.8 100.0 10919 3.5 100.0
N Primary 10114 314513

a o a .o rg.a u 105
Figure HT20 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Bearing Surface and Type of
Femoral Neck (Primary Diagnosis OA)
24% 24%
Exchangeable Ceramic/Ceramic Exchangeable Ceramic/Non XLPE
22% Fixed Ceramic/Ceramic 22% Fixed Ceramic/Non XLPE
20% 20%
18% 18%

16% 16%
14% 14%
12% 12%
10% 10%
8% 8%
6% 6%
4% 4%
2% 2%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
24% 24%
Exchangeable Ceramic/XLPE Exchangeable Metal/Metal
22% Fixed Ceramic/XLPE 22% Fixed Metal/Metal
20% 20%
18% 18%
16% 16%
14% 14%
12% 12%
10% 10%
8% 8%
6% 6%
4% 4%
2% 2%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
24% 24%
Exchangeable Metal/Non XLPE Exchangeable Metal/XLPE
22% Fixed Metal/Non XLPE 22% Fixed Metal/XLPE
20% 20%
18% 18%
16% 16%
14% 14%
12% 12%
10% 10%
8% 8%
6% 6%
4% 4%
2% 2%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Table HT26 Cumulative Percent Revision of Primary Total Conventional Hip Replacement Using an Exchangeable Femoral
Neck by Stem/Neck Metal Combination (Primary Diagnosis OA)
N N
Stem/Neck Metal Combination 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
CoCr/CoCr 83 763 4.1 (2.9, 5.8) 5.9 (4.4, 7.8) 7.5 (5.8, 9.7) 12.1 (9.8, 14.8)
CoCr/Titanium 2 111 1.8 (0.5, 7.0) 1.8 (0.5, 7.0) 1.8 (0.5, 7.0)
Stainless Steel/CoCr 2 46 2.2 (0.3, 14.7) 4.6 (1.2, 17.2) 4.6 (1.2, 17.2) 4.6 (1.2, 17.2)
Titanium/CoCr 206 1680 3.6 (2.8, 4.6) 6.4 (5.3, 7.7) 9.3 (7.9, 10.8) 15.9 (13.7, 18.4)
Titanium/Titanium 398 7514 2.4 (2.1, 2.8) 3.9 (3.5, 4.4) 5.1 (4.6, 5.7) 6.8 (6.1, 7.6) 10.9 (8.5, 14.0)
TOTAL 691 10114
Figure HT21 Cumulative Percent Revision of Primary Total Conventional Hip Replacement Using an Exchangeable Femoral
Neck by Stem/Neck Metal Combination (Primary Diagnosis OA)

24%
Titanium/CoCr Titanium/CoCr vs Titanium/Titanium
22% Titanium/Titanium
0 - 2.5Yr: HR=1.51 (1.19, 1.91),p<0.001
20% 2.5Yr+: HR=3.10 (2.40, 3.99),p<0.001
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Titanium/CoCr 1680 1607 1501 1204 251 16 0
Titanium/Titanium 7514 6935 5716 4224 828 51 10

a o a .o rg.a u 107
Figure HT22 Cumulative Incidence Revision Diagnosis of Primary Total Conventional Hip Replacement Using an Exchangeable
Femoral Neck by Stem/Neck Metal Combination (Primary Diagnosis OA)
Titanium/CoCr Titanium/Titanium
5.0% 5.0%
Loosening Loosening
Fracture Fracture
Metal Related Pathology Metal Related Pathology
3.0% 3.0%
2.0% 2.0%
1.0% 1.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Table HT27 Cumulative Percent Revision of Primary Total Conventional Hip Replacement Using an Exchangeable Femoral
Neck by Prosthesis Type (Primary Diagnosis OA)
N N
Femoral Neck 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
ABGII* 66 228 4.0 (2.1, 7.5) 10.2 (6.9, 15.0) 19.5 (14.8, 25.3)
Adapter* 48 374 3.8 (2.2, 6.3) 7.3 (5.1, 10.5) 10.0 (7.3, 13.6)
Apex 136 2466 2.8 (2.2, 3.5) 4.1 (3.4, 5.0) 5.3 (4.4, 6.3) 7.3 (6.1, 8.8)
F2L* 69 687 3.2 (2.1, 4.8) 5.4 (4.0, 7.4) 6.8 (5.1, 9.0) 8.6 (6.7, 11.0) 12.6 (9.7, 16.4)
Femoral Neck (Amplitude) 17 510 1.0 (0.4, 2.3) 2.2 (1.2, 4.1) 4.4 (2.6, 7.2)
H-Max* 1 71 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 2.2 (0.3, 14.7)
M-Cor* 8 110 0.0 (0.0, 0.0) 2.8 (0.9, 8.4) 4.7 (2.0, 11.0)
M/L Taper Kinectiv 118 2993 2.1 (1.6, 2.6) 3.4 (2.8, 4.1) 4.4 (3.7, 5.3)
MBA* 54 630 2.1 (1.2, 3.5) 4.0 (2.7, 5.9) 5.8 (4.2, 8.1) 9.9 (7.4, 13.0)
MSA* 17 174 7.5 (4.4, 12.6) 9.3 (5.8, 14.7) 9.9 (6.3, 15.5)
Margron* 76 552 5.3 (3.7, 7.5) 7.3 (5.4, 9.9) 9.4 (7.2, 12.2) 14.0 (11.3, 17.3)
Metha* 11 84 10.7 (5.7, 19.6) 11.9 (6.6, 21.0) 11.9 (6.6, 21.0)
Profemur* 54 934 3.1 (2.2, 4.5) 4.7 (3.5, 6.2) 5.2 (4.0, 6.9) 6.4 (4.8, 8.5)
R120* 7 178 1.1 (0.3, 4.4) 2.3 (0.9, 6.1) 2.3 (0.9, 6.1)
Other (5) 9 123 1.7 (0.4, 6.5) 4.7 (2.0, 10.9) 7.1 (3.4, 14.3)
TOTAL 691 10114
Note: Only Femoral Neck Prostheses with over 60 procedures have been listed
* denotes prostheses with no reported use in primary total conventional hip replacement in 2016

Bearing Surface
Bearing surface is a combination of the Comparing the rates of revision for these
material used for the femoral head and bearings, ceramicised metal/XLPE has the
acetabular insert or cup. For this analysis, the lowest rate of revision. As in previous years, the
Registry has identified three types of femoral Registry urges caution in the interpretation of
head (metal, ceramic, and ceramicised metal) this result. This bearing is a single company
and four types of acetabular articular surface product, used with a small number of femoral
(XLPE, non XLPE, ceramic, and metal). stem and acetabular component
Metal/metal bearing surface only includes combinations. This may have a confounding
head sizes 32mm or smaller. effect on the outcome, making it unclear if the
lower rate of revision is an effect of the bearing
XLPE is classified as ultra high molecular weight surface or reflects the limited combination of
polyethylene that has been irradiated by high femoral and acetabular prostheses.
dose (50kGy) gamma or electron beam
radiation. Ceramic/XLPE has a lower rate of revision after
three years compared to metal/XLPE (Table
Comparison of Bearing Surfaces
This year, the Registry is reporting on nine Detailed information on the analysis of metal/metal and metal and ceramic
bearing surfaces are available in the supplementary reports ‘Metal on
bearing surfaces, seven of which have been Metal Bearing Surface Conventional Hip Arthroplasty’ and ‘Metal and
used in more than 5,000 procedures. Ceramic Bearing Surface in Total Conventional Hip Arthroplasty’ on the
AOANJRR website: https://aoanjrr.sahmri.com/annual-reports-2017.
Table HT28 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Bearing Surface (Primary
Diagnosis OA)
N N
Bearing Surface 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Ceramic/Ceramic 2758 78674 1.5 (1.4, 1.6) 2.4 (2.3, 2.5) 3.1 (3.0, 3.2) 5.0 (4.8, 5.2) 7.2 (6.8, 7.7) 7.3 (6.9, 7.8)
Ceramic/Non XLPE 429 6288 1.8 (1.5, 2.2) 3.0 (2.6, 3.5) 3.7 (3.3, 4.3) 7.0 (6.2, 7.8) 11.9 (10.7, 13.2) 13.1 (11.6, 14.7)
Ceramic/XLPE 1276 49627 1.6 (1.5, 1.8) 2.5 (2.3, 2.7) 3.1 (2.9, 3.3) 4.5 (4.1, 4.8) 5.1 (4.6, 5.7)
Ceramic/Metal 18 299 1.7 (0.7, 4.0) 3.7 (2.1, 6.6) 4.4 (2.6, 7.4)
Metal/Metal 347 5146 1.6 (1.3, 1.9) 3.3 (2.9, 3.9) 4.4 (3.8, 5.0) 6.5 (5.8, 7.2) 8.7 (7.7, 9.7) 9.1 (8.0, 10.4)
Metal/Non XLPE 2310 34593 1.4 (1.3, 1.5) 2.4 (2.3, 2.6) 3.4 (3.2, 3.6) 6.3 (6.1, 6.6) 10.5 (10.1, 11.0) 11.3 (10.7, 11.9)
Metal/XLPE 3999 131327 1.6 (1.5, 1.6) 2.3 (2.2, 2.4) 2.9 (2.8, 3.1) 4.4 (4.3, 4.6) 6.3 (5.8, 6.7) 6.3 (5.8, 6.7)
Ceramicised Metal/Non XLPE 36 290 1.7 (0.7, 4.1) 3.9 (2.2, 6.9) 4.3 (2.4, 7.4) 12.5 (8.9, 17.5)
Ceramicised Metal/XLPE 426 18177 1.6 (1.4, 1.7) 2.0 (1.8, 2.3) 2.3 (2.1, 2.6) 3.4 (3.0, 3.8)
TOTAL 11599 324421
Note: Excludes 197 procedures with unknown bearing surface, one procedure with ceramicised metal/ceramic bearing surface and eight
procedures with metal/ceramic bearing surface

a o a .o rg.a u 109
Figure HT23 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Bearing Surface (Primary
Diagnosis OA)
24%
Ceramic/Ceramic
22% Ceramic/Non XLPE
Ceramic/XLPE
20% Metal/Metal
Metal/Non XLPE
18% Metal/XLPE
Ceramicised Metal/XLPE
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Ceramic/Ceramic vs Metal/XLPE Entire Period: HR=1.04 (0.99, 1.09),p=0.165
Ceramic/Non XLPE vs Metal/XLPE 0 - 3Yr: HR=1.30 (1.12, 1.51),p<0.001
3Yr - 5Yr: HR=1.03 (0.73, 1.47),p=0.853
5Yr - 9Yr: HR=1.66 (1.33, 2.08),p<0.001
9Yr+: HR=2.83 (2.34, 3.43),p<0.001
Ceramic/XLPE vs Metal/XLPE 0 - 3Yr: HR=1.07 (1.00, 1.15),p=0.046

3Yr+: HR=0.83 (0.72, 0.95),p=0.006
Metal/Metal vs Metal/XLPE Entire Period: HR=1.36 (1.21, 1.52),p<0.001

Metal/Non XLPE vs Metal/XLPE 0 - 1Mth: HR=0.76 (0.64, 0.89),p=0.001
1Mth - 6Mth: HR=0.98 (0.84, 1.14),p=0.762
6Mth - 1Yr: HR=1.36 (1.13, 1.64),p=0.001
1Yr - 5Yr: HR=1.37 (1.26, 1.50),p<0.001
5Yr - 7Yr: HR=1.67 (1.45, 1.91),p<0.001
7Yr - 9Yr: HR=1.90 (1.64, 2.21),p<0.001
9Yr+: HR=2.46 (2.18, 2.77),p<0.001
Ceramicised Metal/XLPE vs Metal/XLPE 0 - 1Yr: HR=1.03 (0.91, 1.17),p=0.627

1Yr+: HR=0.56 (0.47, 0.66),p<0.001

Ceramic/Ceramic 78674 70863 55391 40220 14612 1355 254
Ceramic/Non XLPE 6288 5678 4808 4179 2835 779 317
Ceramic/XLPE 49627 38561 23126 14232 3208 137 17
Metal/Metal 5146 5023 4779 4500 2907 478 82
Metal/Non XLPE 34593 33199 30698 27752 17001 3096 891
Metal/XLPE 131327 115680 88000 62862 18396 721 86
Ceramicised Metal/XLPE 18177 15762 11498 7709 2123 0 0

Cross-linked Polyethylene
XLPE has been used in 199,131 procedures XLPE is the reason for reduced revision for
reported to the Registry. This includes 7,245 dislocation.
procedures that have XLPE with the addition of
an antioxidant. When polyethylene was used as Reduced cumulative incidence of loosening
a bearing surface in total conventional hip when XLPE is used, is evident for the most
procedures, the proportion of XLPE was 97.1% in common head sizes of 32mm and less than
2016 (Figure HT24). 32mm when compared to non XLPE (Figure
HT29).
Figure HT24 Primary Total Conventional Hip Replacement

by Polyethylene Type (Primary Diagnosis OA)
At 16 years the cumulative percent revision
100%
of total conventional hip replacement with
90% XLPE is 6.2%.
80%
70%
60% XLPE and non XLPE are combined with three

Non XLPE
50% XLPE different femoral head bearing surfaces:
ceramic, metal, and ceramicised metal. Within
40%
each bearing surface, XLPE has a lower rate of
30% revision than non XLPE (Figure HT30).
20%
10%
Prosthesis Specific
0% Further analysis has been undertaken for
specific acetabular prostheses that have both
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
XLPE and non XLPE bearing options and at least

500 procedures in each group. Six prostheses
fulfil these criteria. Five have a reduced rate of
XLPE has a lower rate of revision compared to revision when XLPE is used and for one
non XLPE after six months (Table HT29 and prosthesis there is no difference.
Figure HT25). The difference increases with time
and at 16 years the cumulative percent revision The Allofit Shell has a 14 year follow up with an
is 6.2% and 11.7%, respectively. The cumulative insert using both types of polyethylene. XLPE is
incidence of loosening and prosthesis used in 90.2% of Allofit Shell total conventional
dislocation at 16 years is 1.1% and 1.3% for XLPE, hip procedures. XLPE has a lower rate of
compared to 3.3% and 1.7% for non XLPE revision than non XLPE (Table HT30 and Figure
bearings, respectively (Figure HT26). HT31).
Rates of revision vary depending on head size. The Duraloc Shell has a 14 year follow up with
This is most evident for non XLPE where the rate an insert using both types of polyethylene. XLPE
of revision increases with larger head size. For is used in 36.4% of Duraloc Shell total
XLPE, 32mm head size has the lowest rate of conventional hip procedures. XLPE has a lower
revision. There is no difference between head rate of revision compared to non XLPE (Table
sizes less than 32mm and greater than 32mm HT30 and Figure HT32).
(Table HT29, Figures HT27 and HT28).
The Mallory-Head Shell has an eight year follow
The use of XLPE has been associated with an up with an insert using both types of
increased use of larger head sizes when polyethylene. XLPE is used in 41.9% of Mallory-
compared to non XLPE. Head sizes of 32mm or Head Shell total conventional hip procedures.
greater have been used in 75.9% of XLPE XLPE has a lower rate of revision compared to
procedures and in only 12.0% of non XLPE non XLPE after 1.5 years (Table HT30 and Figure
procedures. The Registry has previously shown HT33).
that this increased use of larger head size with

a o a .o rg.a u 111
The Reflection Cup has a 12 year follow up for The Vitalock Shell has a 13 year follow up with
both types of polyethylene. XLPE has been used an insert using both types of polyethylene. XLPE
in 51.9% of Reflection Cup total conventional is used in 22.7% of Vitalock Shell total
hip procedures. After one year, XLPE has a conventional hip procedures. There is no
lower rate of revision than non XLPE (Table HT30 difference in the rate of revision between XLPE
and Figure HT34). and non XLPE (Table HT30 and Figure HT36).
The Reflection Shell has a 15 year follow up with

Prosthesis Specific (Antioxidant)
an insert using both types of polyethylene. XLPE
is used in 83.7% of Reflection Shell total For the first time, the Registry has performed a
conventional hip procedures. XLPE has a lower separate analysis of acetabular components
rate of revision after one year compared to non that have both XLPE and XLPE with antioxidant.
XLPE (Table HT30 and Figure HT35). There were three components that had both
types of polyethylene: the G7, Trinity, and
Ringloc inserts. There was no difference when
comparing the rate of revision between XLPE
and XLPE with antioxidant within these
prostheses (Table HT31).

Table HT29 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Polyethylene Type and Head Size
Polyethylene N N
Head Size 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Type Revised Total
Non XLPE 2775 41171 1.5 (1.4, 1.6) 2.5 (2.4, 2.7) 3.5 (3.3, 3.7) 6.5 (6.2, 6.8) 10.8 (10.4, 11.3) 11.7 (11.1, 12.3)
<32mm 2538 36230 1.4 (1.3, 1.6) 2.5 (2.3, 2.6) 3.4 (3.2, 3.6) 6.4 (6.2, 6.7) 10.8 (10.3, 11.3) 11.6 (11.1, 12.3)
32mm 213 4642 1.6 (1.3, 2.0) 3.0 (2.5, 3.5) 3.8 (3.2, 4.4) 6.3 (5.4, 7.4)
>32mm 24 299 3.7 (2.1, 6.6) 6.0 (3.8, 9.5) 8.6 (5.7, 12.8)
XLPE 5701 199131 1.6 (1.5, 1.6) 2.3 (2.3, 2.4) 2.9 (2.8, 3.0) 4.4 (4.2, 4.5) 6.0 (5.6, 6.4) 6.2 (5.7, 6.7)
<32mm 1817 48001 1.5 (1.4, 1.7) 2.4 (2.2, 2.5) 3.0 (2.8, 3.2) 4.4 (4.2, 4.7) 6.0 (5.6, 6.5) 6.2 (5.7, 6.8)
32mm 2089 84157 1.5 (1.4, 1.6) 2.3 (2.1, 2.4) 2.7 (2.6, 2.8) 4.0 (3.8, 4.3)
>32mm 1795 66973 1.7 (1.6, 1.8) 2.4 (2.3, 2.6) 3.1 (3.0, 3.3) 4.7 (4.3, 5.0)
TOTAL 8476 240302
Figure HT25 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Polyethylene Type (Primary
Diagnosis OA)

24%
Non XLPE
Non XLPE vs XLPE
22% XLPE
0 - 3Mth: HR=0.82 (0.73, 0.91),p<0.001
20% 3Mth - 6Mth: HR=1.02 (0.82, 1.28),p=0.849
6Mth - 1.5Yr: HR=1.45 (1.27, 1.65),p<0.001
18%
1.5Yr - 2.5Yr: HR=1.31 (1.11, 1.55),p=0.001
16% 2.5Yr - 6.5Yr: HR=1.65 (1.50, 1.81),p<0.001
14% 6.5Yr - 9Yr: HR=2.15 (1.86, 2.49),p<0.001

9Yr+: HR=3.02 (2.60, 3.51),p<0.001
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Non XLPE 41171 39158 35763 32170 19988 3875 1208
XLPE 199131 170003 122624 84803 23727 858 103

a o a .o rg.a u 113
Figure HT26 Cumulative Incidence Revision Diagnosis of Primary Total Conventional Hip Replacement by Polyethylene Type
Non XLPE XLPE
5.0% 5.0%
Loosening Loosening
Fracture Fracture
Lysis Lysis
3.0% 3.0%
2.0% 2.0%
1.0% 1.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Figure HT27 Cumulative Percent Revision of Primary Total Conventional Hip Replacement using Non XLPE by Head Size

24%
Non XLPE <32mm
Non XLPE 32mm vs Non XLPE <32mm
22% Non XLPE 32mm
Non XLPE >32mm Entire Period: HR=1.16 (1.00, 1.33),p=0.045
20%
Non XLPE >32mm vs Non XLPE <32mm
16%
Non XLPE >32mm vs Non XLPE 32mm
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Non XLPE <32mm 36230 34626 32033 29272 19222 3864 1205
32mm 4642 4256 3510 2750 746 11 3
>32mm 299 276 220 148 20 0 0

Figure HT28 Cumulative Percent Revision of Primary Total Conventional Hip Replacement using XLPE by Head Size (Primary
Diagnosis OA)

24%
XLPE <32mm
XLPE <32mm vs XLPE 32mm
22% XLPE 32mm
XLPE >32mm 0 - 1Mth: HR=0.94 (0.82, 1.08),p=0.398
20% 1Mth+: HR=1.13 (1.05, 1.21),p=0.001
18% XLPE >32mm vs XLPE 32mm

16% 0 - 3Mth: HR=1.05 (0.95, 1.15),p=0.334

3Mth+: HR=1.16 (1.07, 1.26),p<0.001
14%
XLPE >32mm vs XLPE <32mm
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

XLPE <32mm 48001 44954 39391 33101 16632 849 102
32mm 84157 70357 47241 29945 5075 2 1
>32mm 66973 54692 35992 21757 2020 7 0

a o a .o rg.a u 115
Figure HT29 Cumulative Incidence Revision Diagnosis of Primary Total Conventional Hip Replacement by Polyethylene Type
and Head Size (Primary Diagnosis OA)
<32mm Non XLPE <32mm XLPE
10.0% 10.0%
Loosening Loosening
Fracture Fracture
Lysis Lysis
6.0% 6.0%
4.0% 4.0%
2.0% 2.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
32mm Non XLPE 32mm XLPE
10.0% 10.0%
Loosening Loosening
Fracture Fracture
Lysis Lysis
6.0% 6.0%
4.0% 4.0%
2.0% 2.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
>32mm Non XLPE >32mm XLPE
10.0% 10.0%
Loosening Loosening
Fracture Fracture
Lysis Lysis
6.0% 6.0%
4.0% 4.0%
2.0% 2.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Figure HT30 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Head Surface and Polyethylene
Type (Primary Diagnosis OA)
24% 24%
Ceramic/Non XLPE Metal/Non XLPE
22% Ceramic/XLPE 22% Metal/XLPE
20% 20%
18% 18%

16% 16%
14% 14%
12% 12%
10% 10%
8% 8%
6% 6%
4% 4%
2% 2%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
24%
Ceramicised Metal/Non XLPE
22% Ceramicised Metal/XLPE
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

a o a .o rg.a u 117
Table HT30 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Prosthesis Type and Polyethylene
Acetabular Polyethylene N N
5 Yrs 8 Yrs 12 Yrs 13 Yrs 14 Yrs 15 Yrs
Component Type Revised Total
Allofit 300 8693 2.6 (2.3, 3.0) 3.9 (3.4, 4.4) 5.7 (5.0, 6.6) 6.2 (5.4, 7.3) 7.6 (6.2, 9.3) 8.8 (6.8, 11.5)
Non XLPE 61 848 3.3 (2.3, 4.7) 5.1 (3.8, 6.9) 8.0 (6.2, 10.4) 8.3 (6.4, 10.7) 9.6 (7.3, 12.5) 11.3 (8.2, 15.5)
XLPE 239 7845 2.5 (2.2, 2.9) 3.7 (3.2, 4.2) 5.0 (4.2, 5.9) 5.7 (4.7, 7.0) 7.2 (5.1, 10.2)
Duraloc 418 4710 3.7 (3.2, 4.2) 5.6 (5.0, 6.4) 10.2 (9.2, 11.3) 11.5 (10.4, 12.7) 12.6 (11.4, 13.9) 13.6 (12.2, 15.1)
Non XLPE 339 2994 4.1 (3.4, 4.8) 6.3 (5.5, 7.3) 12.0 (10.7, 13.4) 13.4 (12.0, 14.8) 14.5 (13.0, 16.1) 15.5 (13.9, 17.3)
XLPE 79 1716 3.0 (2.2, 3.9) 4.3 (3.4, 5.5) 5.5 (4.3, 6.9) 6.5 (5.0, 8.5) 7.1 (5.3, 9.6)
Mallory-Head 307 7030 2.6 (2.2, 3.0) 3.7 (3.2, 4.2) 6.0 (5.2, 6.8) 6.8 (5.9, 7.7) 7.9 (6.9, 9.0) 9.2 (7.9, 10.6)
Non XLPE 246 4084 2.7 (2.3, 3.3) 4.0 (3.4, 4.6) 6.2 (5.5, 7.2) 7.1 (6.2, 8.1) 8.2 (7.1, 9.4) 9.5 (8.2, 11.0)
XLPE 61 2946 2.3 (1.8, 3.0) 2.4 (1.9, 3.2)
Reflection
169 2244 2.8 (2.2, 3.6) 5.4 (4.4, 6.6) 11.1 (9.3, 13.2) 13.8 (11.6, 16.4) 17.6 (14.6, 21.1) 18.7 (15.4, 22.5)
(Cup)
Non XLPE 142 1079 3.3 (2.3, 4.6) 7.5 (6.0, 9.5) 15.4 (12.9, 18.3) 18.1 (15.3, 21.4) 21.8 (18.4, 25.7) 22.7 (19.1, 26.9)
XLPE 27 1165 2.3 (1.5, 3.4) 2.4 (1.6, 3.6) 2.7 (1.8, 4.2)
Reflection
601 14241 2.4 (2.1, 2.7) 3.5 (3.2, 3.8) 5.8 (5.3, 6.3) 6.7 (6.0, 7.3) 7.8 (6.9, 8.7) 9.0 (7.8, 10.2)
(Shell)
Non XLPE 270 2322 4.3 (3.5, 5.2) 6.8 (5.8, 8.0) 12.6 (11.1, 14.3) 14.3 (12.7, 16.1) 15.6 (13.9, 17.6) 16.7 (14.8, 18.8)
XLPE 331 11919 2.0 (1.8, 2.3) 2.7 (2.4, 3.1) 3.6 (3.2, 4.1) 3.8 (3.3, 4.3) 4.5 (3.7, 5.5) 6.3 (4.0, 9.8)
Vitalock 250 4619 2.5 (2.1, 3.0) 3.5 (3.0, 4.1) 5.3 (4.7, 6.1) 5.8 (5.1, 6.6) 6.6 (5.8, 7.5) 7.2 (6.3, 8.2)
Non XLPE 209 3569 2.6 (2.1, 3.1) 3.6 (3.0, 4.2) 5.5 (4.8, 6.4) 6.0 (5.2, 6.9) 6.9 (6.0, 7.9) 7.5 (6.5, 8.6)
XLPE 41 1050 2.4 (1.6, 3.5) 3.3 (2.3, 4.6) 4.7 (3.5, 6.5) 4.7 (3.5, 6.5)
TOTAL 2045 41537
Figure HT31 Cumulative Percent Revision of Allofit Primary Total Conventional Hip Replacement by Polyethylene Type (Primary
Diagnosis OA)

30%
Allofit Non XLPE
Allofit Non XLPE vs Allofit XLPE
Allofit XLPE
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Allofit Non XLPE 848 828 793 738 526 55 7
XLPE 7845 7236 5981 4643 1416 21 0

Figure HT32 Cumulative Percent Revision of Duraloc Primary Total Conventional Hip Replacement by Polyethylene Type

30%
Duraloc Non XLPE
Duraloc Non XLPE vs Duraloc XLPE
Duraloc XLPE
0 - 5Yr: HR=1.34 (0.96, 1.86),p=0.089
25% 5Yr - 9Yr: HR=2.03 (1.26, 3.27),p=0.003
9Yr - 9.5Yr: HR=5.57 (0.74, 42.16),p=0.096
9.5Yr+: HR=3.52 (1.71, 7.22),p<0.001
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Duraloc Non XLPE 2994 2915 2743 2567 1905 398 90
XLPE 1716 1668 1575 1445 643 16 0
Figure HT33 Cumulative Percent Revision of Mallory-Head Primary Total Conventional Hip Replacement by Polyethylene Type

30%
Mallory-Head Non XLPE
Mallory-Head Non XLPE vs Mallory-Head XLPE
Mallory-Head XLPE
0 - 1Mth: HR=0.82 (0.46, 1.45),p=0.497
25% 1Mth - 3Mth: HR=1.63 (0.67, 3.97),p=0.280
3Mth - 1.5Yr: HR=0.87 (0.49, 1.56),p=0.640
1.5Yr+: HR=2.39 (1.30, 4.41),p=0.005
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Mallory-Head Non XLPE 4084 3976 3810 3618 2592 468 177
XLPE 2946 2585 1908 1131 10 0 0

a o a .o rg.a u 119
Figure HT34 Cumulative Percent Revision of Reflection (Cup) Primary Total Conventional Hip Replacement by Polyethylene

30%
Reflection (Cup) Non XLPE
Reflection (Cup) Non XLPE vs
Reflection (Cup) XLPE
Reflection (Cup) XLPE
25% 0 - 1Yr: HR=0.52 (0.19, 1.38),p=0.187
1Yr+: HR=5.09 (2.96, 8.73),p<0.001
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Reflection (Cup) Non XLPE 1079 1052 975 895 564 85 26
XLPE 1165 1096 926 744 254 0 0
Figure HT35 Cumulative Percent Revision of Reflection (Shell) Primary Total Conventional Hip Replacement by Polyethylene

30%
Reflection (Shell) Non XLPE Reflection (Shell) Non XLPE vs
Reflection (Shell) XLPE
Reflection (Shell) XLPE
25% 0 - 1Yr: HR=1.41 (0.98, 2.02),p=0.065
1Yr - 5Yr: HR=3.23 (2.33, 4.49),p<0.001
5Yr - 10Yr: HR=4.44 (3.31, 5.96),p<0.001
20% 10Yr+: HR=6.65 (4.03, 10.97),p<0.001
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Reflection (Shell) Non XLPE 2322 2243 2116 1964 1399 298 97
XLPE 11919 11455 10286 9019 4091 60 6

Figure HT36 Cumulative Percent Revision of Vitalock Primary Total Conventional Hip Replacement by Polyethylene Type

30%
Vitalock Non XLPE
Vitalock Non XLPE vs Vitalock XLPE
Vitalock XLPE
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Vitalock Non XLPE 3569 3477 3331 3162 2564 851 340
XLPE 1050 1032 985 936 687 0 0
Table HT31 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Prosthesis Type and Polyethylene
Acetabular Polyethylene N N
Component Type Revised Total
G7 21 1236 1.7 (1.1, 2.7) 2.3 (1.4, 3.6)
XLPE 3 196 1.0 (0.3, 4.0) 2.1 (0.6, 6.8)
XLPE +
18 1040 1.9 (1.1, 3.0) 2.2 (1.3, 3.7)
Antioxidant
Ringloc 121 5518 1.6 (1.3, 2.0) 2.0 (1.6, 2.4) 2.2 (1.8, 2.6) 2.3 (1.9, 2.8) 2.4 (2.0, 2.9) 2.6 (2.1, 3.1)
XLPE 63 3091 1.4 (1.0, 1.9) 1.7 (1.3, 2.3) 1.8 (1.4, 2.4) 2.0 (1.5, 2.6) 2.2 (1.7, 2.8) 2.3 (1.8, 3.0)
XLPE +
58 2427 2.0 (1.5, 2.6) 2.3 (1.7, 3.0) 2.6 (2.0, 3.4) 2.7 (2.1, 3.5) 2.7 (2.1, 3.5) 2.7 (2.1, 3.5)
Antioxidant
Trinity 47 2815 1.6 (1.2, 2.2) 1.9 (1.4, 2.6) 2.2 (1.6, 3.0) 2.6 (1.7, 4.0) 2.6 (1.7, 4.0)
XLPE 13 718 1.4 (0.7, 2.7) 2.1 (1.1, 3.9) 2.6 (1.4, 5.0) 3.3 (1.7, 6.3) 3.3 (1.7, 6.3)
XLPE +
34 2097 1.7 (1.2, 2.4) 1.9 (1.3, 2.6) 2.0 (1.4, 2.9) 2.0 (1.4, 2.9)
Antioxidant
TOTAL 189 9569

a o a .o rg.a u 121
Ceramic/Ceramic Bearing
Ceramic/ceramic bearings have been used in Mixed ceramic heads with head sizes 36 to
78,674 primary total conventional hip 38mm, and 40mm or larger have a lower rate
replacement procedures undertaken for of revision than 32mm heads. After 1.5 years
osteoarthritis. This is the second most common there is no difference in the rate of revision
bearing reported to the Registry. between 28mm or smaller and 32mm head
sizes. There is no difference in the rate of
This year, analysis has been restricted to revision between 36 to 38mm and 40mm or
procedures with mixed ceramic femoral head larger head sizes (Table HT32 and Figure HT38).
and mixed ceramic acetabular bearing
surfaces. In 2016, mixed ceramic accounted At one year, the cumulative incidence of
for 92.0% of all procedures with revision for dislocation is 2.0% for head sizes
ceramic/ceramic bearing surface (Figure 28mm or smaller compared to 0.4% for 32mm,
HT37). 0.3% for 36 to 38mm, and 0.1% for head sizes
40mm or larger (Figure HT39).
Head Size
To evaluate the effect of head size, an
analysis was undertaken comparing four head
size groups (≤28, 32, 36-38 and ≥40mm). Head
sizes 36mm and 38mm have been combined
in this analysis.
Figure HT37 Primary Total Conventional Hip Replacement with Ceramic Femoral Head by Ceramic Type (Primary Diagnosis
OA)
100%
90%
80%
70%
60%
Zirconia
50% Alumina
Mixed Ceramic
40%
30%
20%
10%
0%
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20

Table HT32 Cumulative Percent Revision of Mixed Ceramic/Mixed Ceramic Primary Total Conventional Hip Replacement by
Head Size (Primary Diagnosis OA)
N N
Revised Total
≤28mm 30 564 3.4 (2.2, 5.3) 4.0 (2.6, 6.0) 4.7 (3.2, 6.9) 5.6 (3.9, 8.1)
32mm 242 8384 1.9 (1.6, 2.2) 2.7 (2.4, 3.1) 3.3 (2.9, 3.7)
36-38mm 792 32734 1.4 (1.2, 1.5) 2.2 (2.0, 2.4) 2.8 (2.6, 3.0) 4.4 (3.9, 4.9)
≥40mm 129 6027 1.1 (0.8, 1.4) 1.8 (1.5, 2.2) 2.6 (2.2, 3.1)
TOTAL 1193 47709
Figure HT38 Cumulative Percent Revision of Mixed Ceramic/Mixed Ceramic Primary Total Conventional Hip Replacement by
Head Size (Primary Diagnosis OA)

24%
≤28mm ≤28mm vs 32mm
22% 32mm
0 - 2Wk: HR=2.18 (0.80, 5.94),p=0.126
36-38mm
20% ≥40mm 2Wk - 1.5Yr: HR=1.79 (1.08, 2.98),p=0.024
1.5Yr+: HR=0.69 (0.36, 1.34),p=0.277
18%
36-38mm vs 32mm
16%
14%
≥40mm vs 32mm
12%
10%
36-38mm vs ≥40mm
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

≤28mm 564 518 434 371 218 0 0
32mm 8384 7136 4832 2625 2 0 0
36-38mm 32734 27885 18461 10330 631 0 0
≥40mm 6027 5482 4047 2144 0 0 0

a o a .o rg.a u 123
Figure HT39 Cumulative Incidence Revision Diagnosis of Mixed Ceramic/Mixed Ceramic Primary Total Conventional Hip
Replacement by Head Size (Primary Diagnosis OA)
≤28mm 32mm
5.0% 5.0%
Loosening Loosening
Fracture Fracture
Pain Pain
3.0% 3.0%
2.0% 2.0%
1.0% 1.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
36-38mm ≥40mm
5.0% 5.0%
Loosening Loosening
Fracture Fracture
Pain Pain
3.0% 3.0%
2.0% 2.0%
1.0% 1.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Constrained Acetabular Prostheses Dual Mobility Acetabular Prostheses

Constrained acetabular prostheses have a Dual mobility prostheses have a femoral head
mechanism to lock the femoral head into the which moves within a polyethylene
acetabular component. Although often component, which also moves within a fixed
considered ‘revision’ components, there have acetabular shell.
been 1,923 procedures used for primary total
conventional hip replacement. Of these, 725 There have been 3,948 primary total
procedures using constrained acetabular conventional hip replacement procedures
inserts and 1,198 procedures using constrained using dual mobility prostheses. Compared to
cups. There were 64 procedures reported in other acetabular prostheses, dual mobility
2016. This is an increase of 3.1% compared to acetabular prostheses are proportionally used
2015. more frequently for fractured neck of femur,
tumour, and failed internal fixation (Table HT39).
Constrained acetabular prostheses are
proportionally used more frequently for When all diagnoses are included, dual mobility
fractured neck of femur, tumour, failed internal prostheses have a higher rate of revision
fixation, and fracture/dislocation compared to compared to other acetabular prostheses
all other acetabular components (Table HT33). (Table HT40 and Figure HT45).
When all diagnoses are included, there is no For the diagnosis of osteoarthritis, there is no
difference in the rate of revision for constrained difference in the rate of revision when dual
prostheses compared to other acetabular mobility prostheses are used (Table HT41 and
prostheses (Table HT34 and Figure HT40). This is Figure HT46).
also true when only those procedures with a
diagnosis of osteoarthritis are included (Table
HT35 and Figure HT41). Gender is not a risk
factor for revision (Table HT36 and Figure HT42).
However, there is a difference in outcome with

respect to age. Constrained prosthesis have a
higher rate of revision if they are used in
patients aged less than 70 years (Table HT37
and Figure HT43). There is no difference in the
rate of revision related to fixation (Table HT38
and Figure HT44).

a o a .o rg.a u 125
Table HT33 Primary Total Conventional Hip Replacement by Primary Diagnosis and Acetabular Type
Constrained Prosthesis Other Acetabular Prosthesis

Diagnosis N Col% N Col%
Osteoarthritis 765 39.8 323862 88.8
Fractured Neck Of Femur 678 35.3 15187 4.2
Osteonecrosis 73 3.8 11978 3.3
Developmental Dysplasia 19 1.0 4537 1.2
Rheumatoid Arthritis 22 1.1 3711 1.0
Tumour 214 11.1 1863 0.5
Failed Internal Fixation 108 5.6 1515 0.4
Other Inflammatory Arthritis 5 0.3 1589 0.4
Fracture/Dislocation 28 1.5 413 0.1
Arthrodesis Takedown 8 0.4 109 0.0
Other 3 0.2 137 0.0
TOTAL 1923 100.0 364901 100.0

Table HT34 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Acetabular Type (All
Diagnoses)
N N
Acetabular Type 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Constrained Prosthesis 71 1923 1.8 (1.3, 2.5) 3.1 (2.4, 4.1) 4.1 (3.2, 5.3) 6.4 (4.8, 8.6)
Other Acetabular Prosthesis 13693 364901 1.7 (1.6, 1.7) 2.6 (2.5, 2.7) 3.3 (3.2, 3.4) 5.4 (5.3, 5.5) 8.4 (8.2, 8.6) 9.0 (8.7, 9.4)
TOTAL 13764 366824
Figure HT40 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Acetabular Type (All
Diagnoses)

24%
Constrained Prosthesis
Constrained Prosthesis vs
22% Other Acetabular Prosthesis
Other Acetabular Prosthesis
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Constrained Prosthesis 1923 1560 1140 736 209 14 4
Other Acetabular Prosthesis 364901 318535 242906 179211 67627 7405 1881

a o a .o rg.a u 127
Table HT35 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Acetabular Type (Primary
Diagnosis OA)
N N
Revised Total
Constrained Prosthesis 27 765 0.9 (0.4, 1.9) 2.5 (1.6, 4.1) 3.7 (2.5, 5.5) 4.5 (3.1, 6.7)
TOTAL 11610 324627
Figure HT41 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Acetabular Type (Primary
Diagnosis OA)

24%
Constrained Prosthesis
Constrained Prosthesis vs
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16


Table HT36 Cumulative Percent Revision of Constrained Primary Total Conventional Hip Replacement by Gender (Primary
Diagnosis OA)
N N
Acetabular Type Gender 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Constrained Prosthesis Male 8 256 1.2 (0.4, 3.6) 2.2 (0.9, 5.3) 3.6 (1.7, 7.5)
Female 19 509 0.8 (0.3, 2.1) 2.7 (1.5, 4.6) 3.7 (2.3, 6.1) 4.5 (2.8, 7.2)
TOTAL 27 765
Figure HT42 Cumulative Percent Revision of Constrained Primary Total Conventional Hip Replacement by Gender (Primary
Diagnosis OA)

24%
Constrained Prosthesis Male
Constrained Prosthesis Female vs
22% Constrained Prosthesis Female
Constrained Prosthesis Male
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Constrained Prosthesis Male 256 225 163 114 33 0 0
Female 509 470 397 288 120 9 2

a o a .o rg.a u 129
Table HT37 Cumulative Percent Revision of Constrained Primary Total Conventional Hip Replacement by Age (Primary
Diagnosis OA)
N N
Acetabular Type Age 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Constrained Prosthesis <70 12 130 2.4 (0.8, 7.1) 6.1 (2.9, 12.4) 9.1 (5.0, 16.4)
≥70 15 635 0.6 (0.2, 1.7) 1.8 (1.0, 3.3) 2.5 (1.5, 4.4) 3.2 (1.9, 5.4)
TOTAL 27 765
Figure HT43 Cumulative Percent Revision of Constrained Primary Total Conventional Hip Replacement by Age (Primary
Diagnosis OA)

24%
Constrained Prosthesis <70
Constrained Prosthesis <70 vs
22% Constrained Prosthesis ≥70
Constrained Prosthesis ≥70
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Constrained Prosthesis <70 130 117 95 73 38 5 0
≥70 635 578 465 329 115 4 2

Table HT38 Cumulative Percent Revision of Constrained Primary Total Conventional Hip Replacement by Fixation (Primary
Diagnosis OA)
N N
Acetabular Type Fixation 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Constrained Prosthesis Cemented 12 388 0.5 (0.1, 2.1) 1.7 (0.8, 3.8) 2.8 (1.4, 5.3) 3.8 (2.1, 6.8)
Cementless 7 112 1.8 (0.5, 7.0) 4.3 (1.6, 11.3) 7.6 (3.4, 16.6)
Hybrid 8 265 1.2 (0.4, 3.6) 3.1 (1.5, 6.4) 3.7 (1.9, 7.4) 3.7 (1.9, 7.4)
TOTAL 27 765
Figure HT44 Cumulative Percent Revision of Constrained Primary Total Conventional Hip Replacement by Fixation (Primary
Diagnosis OA)

24%
Constrained Prosthesis Cemented
Constrained Prosthesis Cementless vs
22% Constrained Prosthesis Cementless
Constrained Prosthesis Hybrid Constrained Prosthesis Cemented
18% Constrained Prosthesis Hybrid vs

16% Constrained Prosthesis Cemented

14%
Constrained Prosthesis Cementless vs
12%
Constrained Prosthesis Hybrid
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Constrained Prosthesis Cemented 388 363 306 229 97 4 0
Cementless 112 95 69 45 14 1 0
Hybrid 265 237 185 128 42 4 2

a o a .o rg.a u 131
Table HT39 Primary Diagnosis of Primary Total Conventional Hip Replacement by Acetabular Mobility
Dual Mobility Prosthesis Other Acetabular Prosthesis

Diagnosis N Col% N Col%
Osteoarthritis 2467 62.5 322160 88.8
Fractured Neck Of Femur 954 24.2 14911 4.1
Osteonecrosis 153 3.9 11898 3.3
Developmental Dysplasia 62 1.6 4494 1.2
Rheumatoid Arthritis 24 0.6 3709 1.0
Tumour 137 3.5 1940 0.5
Failed Internal Fixation 94 2.4 1529 0.4
Other Inflammatory Arthritis 15 0.4 1579 0.4
Fracture/Dislocation 31 0.8 410 0.1
Arthrodesis Takedown 7 0.2 110 0.0
Other 4 0.1 136 0.0
TOTAL 3948 100.0 362876 100.0

Table HT40 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Acetabular Mobility (All
Diagnoses)
N N
Acetabular Mobility 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Dual Mobility Prosthesis 104 3948 2.2 (1.7, 2.7) 3.2 (2.6, 3.9) 4.4 (3.4, 5.8)
TOTAL 13764 366824
Figure HT45 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Acetabular Mobility (All
Diagnoses)

24%
Dual Mobility Prosthesis
Dual Mobility Prosthesis vs
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Dual Mobility Prosthesis 3948 2450 882 256 5 0 0

a o a .o rg.a u 133
Table HT41 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Acetabular Mobility (Primary
Diagnosis OA)
N N
Revised Total
Dual Mobility Prosthesis 47 2467 1.6 (1.2, 2.2) 2.4 (1.8, 3.3) 2.8 (1.9, 4.1)
TOTAL 11610 324627
Figure HT46 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Acetabular Mobility (Primary
Diagnosis OA)

24%
Dual Mobility Prosthesis
Dual Mobility Prosthesis vs
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16



This year, the Registry has undertaken a Registry for a diagnosis of fractured neck of
separate analysis of the outcome of primary femur. The cumulative percent revision of
total conventional hip replacement for primary total conventional hip replacement
fractured neck of femur. at 10 years for fractured neck of femur is 7.9%
(Table HT42 and Figure HT47).
There have been 15,865 total conventional
hip replacement procedures recorded by the
Table HT42 Cumulative Percent Revision of Primary Total Conventional Hip Replacement (Primary Diagnosis Fractured NOF)
N N
Revised Total
TOTAL 763 15865
Figure HT47 Cumulative Percent Revision of Primary Total Conventional Hip Replacement (Primary Diagnosis Fractured NOF)
20%
Total Conventional
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16


a o a .o rg.a u 135
Reasons for Revision Type of Revision

Prosthesis dislocation (32.9%) is the most Replacement of the femoral component only
common reason for revision, followed by is the most common type of revision (35.6%),
fracture (27.1%), loosening (16.6%), and followed by head and insert (21.0%),
infection (16.0%) (Table HT43 and Figure acetabular only (20.4%), and total hip
HT48). replacement (femoral/acetabular) (8.4%)
(Table HT44).
Table HT43 Primary Total Conventional Hip Replacement Table HT44 Primary Total Conventional Hip Replacement
by Reason for Revision (Primary Diagnosis Hip Replacement by Type of Revision
Fractured NOF) (Primary Diagnosis Fractured NOF)

Prosthesis Dislocation 251 32.9 Femoral Component 272 35.6
Fracture 207 27.1 Head/Insert 160 21.0
Loosening 127 16.6 Acetabular Component 156 20.4
Pain 9 1.2 Head Only 38 5.0
Malposition 7 0.9 Cement Spacer 34 4.5
Implant Breakage Stem 7 0.9 Minor Components 17 2.2
Lysis 6 0.8 Insert Only 10 1.3
Implant Breakage Acetabular 5 0.7 Removal of Prostheses 3 0.4
Leg Length Discrepancy 5 0.7 Head/Neck/Insert 3 0.4
Metal Related Pathology 3 0.4 Reinsertion of Components 2 0.3
Incorrect Sizing 3 0.4 Head/Neck 2 0.3
Instability 3 0.4 Total Femoral 1 0.1
Implant Breakage Acetabular Neck Only 1 0.1
3 0.4
Insert TOTAL 763 100.0
Heterotopic Bone 2 0.3
Wear Acetabular Insert 1 0.1 Note: Femoral heads are usually replaced when the acetabular
Other 2 0.3 component and/or femoral stem is revised
All procedures using metal/metal prostheses with head
TOTAL 763 100.0 size larger than 32mm have been excluded
Note: All procedures using metal/metal prostheses with head

size larger than 32mm have been excluded
Figure HT48 Cumulative Incidence Revision Diagnosis of Primary Total Conventional Hip Replacement (Primary Diagnosis
Fractured NOF) Total Conventional
5.0%
Prosthesis Dislocation
Fracture
Loosening
4.0% Infection
Pain
3.0%
2.0%
1.0%
0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Fixation
The analysis for fractured neck of femur and difference after this time (Table HT45 and
fixation has been performed on modern Figure HT49).
bearing surfaces and restricted to
ceramic/ceramic and all femoral head There are differences in outcome with respect
materials used in combination with XLPE. to fixation and age. For patients aged less
than 70 years, there is no difference in the
The Registry has recorded 764 procedures rate for revision between the three different
with cemented fixation, 4,670 with cementless fixation methods (Table HT46 and Figure
fixation and 7,436 with hybrid fixation. HT50). For patients aged 70 years or older,
Cemented fixation has a lower rate of revision cementless fixation has a higher rate of
for all time periods compared to cementless revision than cemented fixation for all time
fixation and compared to hybrid fixation after periods, and for the first three months
3 months. Cementless fixation has a higher compared to hybrid fixation. Hybrid fixation
rate of revision than hybrid fixation for the first has a higher rate of revision compared to
three months only, and then there is no cemented fixation after one month (Table
Table HT45 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Fixation (Primary Diagnosis
Fractured NOF)
N N
Revised Total
Cemented 17 764 1.9 (1.1, 3.2) 2.3 (1.4, 3.8) 2.6 (1.6, 4.3) 2.6 (1.6, 4.3)
Cementless 269 4670 4.0 (3.5, 4.6) 4.9 (4.3, 5.6) 5.6 (4.9, 6.3) 6.3 (5.5, 7.1) 6.8 (6.0, 7.8) 8.7 (7.4, 10.3)
Hybrid 314 7436 2.7 (2.4, 3.1) 3.6 (3.2, 4.1) 4.2 (3.7, 4.7) 5.2 (4.6, 5.9) 6.4 (5.6, 7.3) 7.0 (6.1, 8.1)
TOTAL 600 12870
Figure HT49 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Fixation (Primary Diagnosis
Fractured NOF)

20%
Cementless
18% 0 - 3Mth: HR=1.01 (0.57, 1.78),p=0.985
Hybrid
3Mth+: HR=0.27 (0.10, 0.73),p=0.009
16%
14%
0 - 3Mth: HR=1.71 (1.35, 2.17),p<0.001

3Mth+: HR=0.94 (0.75, 1.18),p=0.572
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Cemented 764 548 411 280 97 28 3
Cementless 4670 3778 3139 2600 1701 930 321
Hybrid 7436 5659 4474 3455 1994 1071 316

a o a .o rg.a u 137
Table HT46 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Age and Fixation (Primary
N N
Age Fixation 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
<70 Cemented 6 159 3.4 (1.4, 8.0) 3.4 (1.4, 8.0) 4.9 (2.1, 11.1)
Cementless 108 1862 3.7 (2.9, 4.7) 4.7 (3.8, 5.8) 5.6 (4.5, 6.8) 6.2 (5.1, 7.5) 6.8 (5.6, 8.4) 8.9 (7.0, 11.3)
Hybrid 105 2291 2.8 (2.2, 3.6) 3.8 (3.0, 4.7) 4.4 (3.5, 5.4) 5.4 (4.3, 6.6) 6.6 (5.3, 8.2) 7.5 (5.8, 9.8)
≥70 Cemented 11 605 1.6 (0.8, 3.0) 2.1 (1.1, 3.7) 2.1 (1.1, 3.7) 2.1 (1.1, 3.7)
Cementless 161 2808 4.2 (3.5, 5.1) 5.1 (4.3, 6.0) 5.6 (4.7, 6.5) 6.3 (5.4, 7.4) 6.8 (5.7, 8.0) 8.4 (6.8, 10.3)
Hybrid 209 5145 2.7 (2.3, 3.2) 3.6 (3.1, 4.2) 4.1 (3.5, 4.7) 5.2 (4.4, 6.0) 6.4 (5.4, 7.5) 6.7 (5.7, 7.9)
TOTAL 600 12870
Figure HT50 Cumulative Percent Revision of Primary Total Conventional Hip Replacement in Patients Aged <70 Years by

20%
<70 Cemented <70 Cemented vs <70 Hybrid
<70 Cementless
<70 Hybrid
16% <70 Cementless vs <70 Hybrid

14%
<70 Cementless vs <70 Cemented

10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

<70 Cemented 159 104 79 57 20 8 1
Cementless 1862 1542 1306 1085 749 447 188
Hybrid 2291 1777 1416 1125 699 394 135

Figure HT51 Cumulative Percent Revision of Primary Total Conventional Hip Replacement in Patients Aged ≥ 70 Years by

20%
≥70 Cemented ≥70 Cementless vs ≥70 Cemented
≥70 Cementless
≥70 Hybrid
16% ≥70 Hybrid vs ≥70 Cemented

0 - 1Mth: HR=1.23 (0.62, 2.44),p=0.552
14%
1Mth+: HR=2.50 (1.34, 4.67),p=0.004
12% ≥70 Cementless vs ≥70 Hybrid

0 - 3Mth: HR=1.92 (1.44, 2.56),p<0.001
10%
3Mth+: HR=0.88 (0.66, 1.19),p=0.420
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

≥70 years Cemented 605 444 332 223 77 20 2
Cementless 2808 2236 1833 1515 952 483 133
Hybrid 5145 3882 3058 2330 1295 677 181

a o a .o rg.a u 139
Head Size
Head size 32mm has a lower rate of revision revision compared to other acetabular
after three months compared to head sizes prostheses (Table HT48 and Figure HT53).
less than 32mm. There is no difference when
Dual Mobility
36mm or larger head sizes are compared to
head sizes both less than 32mm or 32mm There is no difference in the rate of revision
(Table HT47 and Figure HT52). when dual mobility prostheses are used
(Table HT49 and Figure HT54).
Constrained Acetabular Prostheses
When used for fractured neck of femur,
constrained prostheses have a lower rate of
Table HT47 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Head Size (Primary Diagnosis
Fractured NOF)
N N
Revised Total
<32mm 255 4290 3.1 (2.6, 3.7) 4.1 (3.5, 4.8) 4.6 (4.0, 5.4) 5.8 (5.0, 6.7) 7.1 (6.2, 8.1) 9.1 (7.9, 10.5)
32mm 274 6736 2.8 (2.4, 3.3) 3.5 (3.1, 4.0) 4.1 (3.6, 4.7) 4.7 (4.2, 5.4) 5.4 (4.7, 6.1) 6.2 (5.2, 7.3)
≥36mm 234 4813 3.2 (2.7, 3.8) 4.3 (3.8, 5.0) 4.8 (4.2, 5.6) 5.9 (5.1, 6.7) 6.9 (5.9, 8.0) 8.2 (6.8, 9.9)
TOTAL 763 15839
Excludes 26 procedures with unknown head size
Figure HT52 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Head Size (Primary Diagnosis
Fractured NOF)

20%
<32mm <32mm vs 32mm
32mm
18% 0 - 1Mth: HR=0.88 (0.62, 1.25),p=0.468
≥36mm
1Mth - 3Mth: HR=1.19 (0.82, 1.72),p=0.360
16% 3Mth+: HR=1.52 (1.23, 1.88),p<0.001
14%
≥36mm vs 32mm
12%
≥36mm vs <32mm
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

<32mm 4290 3406 2841 2415 1734 1260 713
32mm 6736 5347 4334 3415 2050 1075 302
≥36mm 4813 3677 2980 2357 1357 612 105

Table HT48 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Acetabular Type (Primary
N N
Revised Total
Constrained Prosthesis 14 678 1.3 (0.6, 2.5) 1.7 (0.9, 3.1) 2.4 (1.4, 4.1) 2.4 (1.4, 4.1) 2.9 (1.6, 5.0)
TOTAL 763 15865
Figure HT53 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Acetabular Type (Primary

20%
Constrained Prosthesis Constrained Prosthesis vs
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16


a o a .o rg.a u 141
Table HT49 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Acetabular Mobility (Primary
N N
Revised Total
Dual Mobility Prosthesis 30 954 2.4 (1.6, 3.7) 3.6 (2.4, 5.3) 3.6 (2.4, 5.3) 5.2 (3.1, 8.7)
TOTAL 763 15865
Figure HT54 Cumulative Percent Revision of Primary Total Conventional Hip Replacement by Acetabular Mobility (Primary

20%
Dual Mobility Prosthesis Dual Mobility Prosthesis vs
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16


OUTCOME OF TOTAL CONVENTIONAL COMPARED TO PARTIAL HIP REPLACEMENT

The rate of revision of total conventional hip unipolar monoblock components in those
replacement was compared to unipolar aged less than 70 years may represent its use
monoblock, unipolar modular and bipolar hip in patients with significant co-morbidities.
replacement for fractured neck of femur. Unipolar modular has a lower rate of revision
than total conventional hip replacement for
Unipolar monoblock hip replacement has a the first three moths, but after this time it is
higher rate of revision than total conventional higher. There is no difference between
hip replacement after three months. Unipolar bipolar and total conventional hip
modular hip replacement has a lower rate of replacement in this age group (Table HT51
revision than total conventional hip and Figure HT56).
replacement for the first three months. From
three months to 1.5 years there is no For patients aged 70 years or older, there are
difference, but after this time it has a higher time dependent variations in the
rate of revision. Bipolar hip replacement has a comparative rates of revision. Unipolar
lower rate of revision for the first two weeks monoblock has a higher rate of revision
compared to total conventional hip compared to total conventional hip
replacement, but after this time there is no replacement between three months and one
difference (Table HT50 and Figure HT55). year. Unipolar modular has a lower rate of
revision for the first 1.5 years. After 1.5 years
For patients under 70 years of age, unipolar there is no difference. Bipolar hip
monoblock has a higher rate of revision after replacement has a lower rate of revision than
three months compared to total total conventional hip replacement for the
conventional hip replacement. The use of entire period (Table HT51 and Figure HT57).

a o a .o rg.a u 143
Table HT50 Cumulative Percent Revision of Primary Hip Replacement by Class (Primary Diagnosis Fractured NOF)
N N
Revised Total
Bipolar 606 17486 2.3 (2.0, 2.5) 3.1 (2.8, 3.4) 3.7 (3.4, 4.0) 4.4 (4.0, 4.8) 5.0 (4.6, 5.5) 6.4 (5.7, 7.0)
TOTAL 3552 95090
Figure HT55 Cumulative Percent Revision of Primary Hip Replacement by Class (Primary Diagnosis Fractured NOF)

20%
Unipolar Monoblock Unipolar Monoblock vs Total Conventional
Unipolar Modular
18% 0 - 3Mth: HR=0.99 (0.85, 1.15),p=0.887
Bipolar
Total Conventional 3Mth+: HR=1.75 (1.55, 1.98),p<0.001
16%
Unipolar Modular vs Total Conventional
14%
0 - 3Mth: HR=0.77 (0.66, 0.89),p<0.001

3Mth - 1.5Yr: HR=0.94 (0.80, 1.10),p=0.447
12%
1.5Yr+: HR=1.69 (1.46, 1.95),p<0.001
10%
Bipolar vs Total Conventional
0 - 2Wk: HR=0.61 (0.42, 0.88),p=0.007
8%
2Wk - 1Mth: HR=0.93 (0.73, 1.19),p=0.573
6% 1Mth - 1.5Yr: HR=0.92 (0.79, 1.07),p=0.264
1.5Yr+: HR=1.16 (0.98, 1.38),p=0.089
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Bipolar 17486 12050 9300 7415 4866 3191 1598

Table HT51 Cumulative Percent Revision of Primary Hip Replacement by Class and Age (Primary Diagnosis Fractured NOF)
N N
Age Hip Class 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs
Revised Total
<70 734 10575 3.0 (2.7, 3.4) 4.7 (4.3, 5.1) 6.1 (5.6, 6.6) 7.8 (7.2, 8.5) 9.7 (9.0, 10.5) 11.7 (10.8, 12.7)
Bipolar 123 1909 2.5 (1.8, 3.3) 4.7 (3.7, 5.8) 5.8 (4.7, 7.1) 6.7 (5.5, 8.2) 8.4 (6.9, 10.1) 10.1 (8.4, 12.2)
≥70 2818 84515 2.4 (2.3, 2.5) 3.2 (3.1, 3.3) 3.7 (3.6, 3.9) 4.6 (4.5, 4.8) 5.4 (5.2, 5.7) 6.5 (6.1, 6.8)
Bipolar 483 15577 2.2 (2.0, 2.5) 2.8 (2.6, 3.2) 3.4 (3.0, 3.7) 4.0 (3.7, 4.5) 4.4 (4.0, 4.9) 5.6 (5.0, 6.3)
TOTAL 3552 95090
Figure HT56 Cumulative Percent Revision of Primary Hip Replacement in Patients Aged <70 Years by Class (Primary

20%
<70 Unipolar Monoblock <70 Unipolar Monoblock vs
<70 Unipolar Modular
18% <70 Total Conventional
<70 Bipolar
<70 Total Conventional 0 - 3Mth: HR=0.93 (0.55, 1.56),p=0.781
16% 3Mth+: HR=2.19 (1.65, 2.89),p<0.001
14%
<70 Unipolar Modular vs <70 Total Conventional

0 - 3Mth: HR=0.64 (0.45, 0.93),p=0.018
12%
3Mth - 3Yr: HR=1.65 (1.29, 2.10),p<0.001
10% 3Yr+: HR=2.91 (2.19, 3.86),p<0.001
8% <70 Bipolar vs <70 Total Conventional

6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

<70 Unipolar Monoblock 886 597 494 410 282 202 108
Bipolar 1909 1453 1188 1039 814 638 407

a o a .o rg.a u 145
Figure HT57 Cumulative Percent Revision of Primary Hip Replacement in Patients Aged ≥70 Years by Class (Primary Diagnosis
Fractured NOF)

20%
≥70 Unipolar Monoblock ≥70 Unipolar Monoblock vs
≥70 Unipolar Modular
18% ≥70 Total Conventional
≥70 Bipolar
≥70 Total Conventional 0 - 2Wk: HR=1.13 (0.85, 1.50),p=0.392
16% 2Wk - 3Mth: HR=0.68 (0.57, 0.81),p<0.001
3Mth - 6Mth: HR=1.38 (1.05, 1.83),p=0.022
14%
6Mth - 1Yr: HR=1.72 (1.36, 2.18),p<0.001
12% 1Yr+: HR=1.12 (0.96, 1.31),p=0.163
10% ≥70 Unipolar Modular vs ≥70 Total Conventional

0 - 3Mth: HR=0.64 (0.55, 0.75),p<0.001
8% 3Mth - 1.5Yr: HR=0.76 (0.63, 0.91),p=0.002
1.5Yr+: HR=1.03 (0.87, 1.22),p=0.749
6%
≥70 Bipolar vs ≥70 Total Conventional
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

≥70 Unipolar Monoblock 26567 16030 12248 9211 4953 2626 937
Bipolar 15577 10597 8112 6376 4052 2553 1191

Competing Risk
The Registry typically presents the outcomes of For patients aged less than 70 years of age the
joint replacement in terms of Kaplan-Meier cumulative incidence of mortality at 10 years
estimates of the survival of the primary for unipolar monoblock is 70.0%, for unipolar
procedure. Using the Kaplan-Meier method, modular 52.2%, for bipolar 47.7% and for total
observations are censored at the close of the conventional hip 26.0% (Table HT52 and Figure
database or at the time of death if a revision HT58). The cumulative incidence of revision for
has not occurred. These patients are then unipolar monoblock at 10 years is 9.0%, for
assumed to have the same chance of revision unipolar modular 11.2%, bipolar 7.6%, and total
in the future as those whose follow up is not conventional 8.4% (Table HT53 and Figure
censored. However, if a patient dies they HT59).
cannot be revised. Death is therefore a
competing risk to revision. In the presence of a For patients aged 70 years or older the
competing risk, such as death, Kaplan-Meier is cumulative incidence of mortality at 10 years
known to overestimate the probability of for unipolar monoblock is 90.2%, for unipolar
revision. This is especially so if the incidence of modular 81.6%, for bipolar 78.4% and for total
the competing risk is high. conventional hip 64.8% (Table HT54 and Figure
HT60). The cumulative incidence of revision for
As there is a higher incidence of mortality with unipolar monblock at 10 years is 3.7%, for
patients undergoing joint replacement for unipolar modular 3.5%, bipolar 3.6% and total
fractured neck of femur, the Registry has for conventional 5.4% (Table HT55 and Figure
the first time, estimated the probability of HT61).
revision in the presence of competing risks
using cumulative incidence. This analysis can When compared to the Kaplan-Meier
be compared to the traditional Kaplan-Meier estimates of revision it can be seen that there is
method. a lower risk of revision for patients when the
competing risk approach is used. This is
In order to further investigate the impact of the because of the high mortality of patients with
competing risk of death, the cumulative a diagnosis of fractured neck of femur.
incidence graphs of mortality and revision are
provided for patients under 70 years and 70
years or older.

a o a .o rg.a u 147
Table HT52 Cumulative Incidence Mortality of Primary Hip Replacement in Patients Aged <70 Years by Class (Primary

Unipolar Monoblock 28.0 36.8 43.5 55.5 62.0 70.0
Unipolar Modular 17.2 24.4 29.1 37.5 44.8 52.2
Bipolar 14.2 20.3 24.8 31.6 39.1 47.0
Total Conventional 4.9 7.4 9.9 14.8 18.8 26.0
Figure HT58 Cumulative Incidence Mortality of Primary Hip Replacement in Patients Aged <70 Years by Class (Primary
100%
Unipolar Monoblock
Unipolar Modular
90%
Bipolar
Total Conventional
80%
Cumulative Incidence Mortality
70%
60%
50%
40%
30%
20%
10%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Number at Risk 0 Yr 1 Yrs 2 Yrs 3 Yrs 5 Yrs 7 Yrs 10 Yrs

Bipolar 1909 1453 1188 1039 814 638 407

Table HT53 Cumulative Incidence Revision of Primary Hip Replacement in Patients Aged <70 Years by Class (Primary Diagnosis
Fractured NOF)

Unipolar Monoblock 3.5 (2.4, 4.9) 5.5 (4.1, 7.1) 7.1 (5.6, 9.0) 8.5 (6.7, 10.5) 9.0 (7.2, 11.1) 9.0 (7.2, 11.1)
Unipolar Modular 2.3 (1.8, 2.9) 4.0 (3.3, 4.7) 5.6 (4.8, 6.5) 8.0 (7.0, 9.2) 9.9 (8.7, 11.2) 11.2 (9.8, 12.7)
Bipolar 2.3 (1.7, 3.1) 4.1 (3.3, 5.1) 5.0 (4.0, 6.1) 5.6 (4.6, 6.8) 6.7 (5.5, 8.0) 7.6 (6.4, 9.1)
Total Conventional 3.2 (2.8, 3.8) 4.2 (3.7, 4.8) 4.9 (4.3, 5.6) 5.7 (5.0, 6.5) 6.8 (6.0, 7.7) 8.4 (7.3, 9.6)
Figure HT59 Cumulative Incidence Revision of Primary Hip Replacement in Patients Aged <70 Years by Class (Primary
20%
Unipolar Monoblock
Unipolar Modular
18%
Bipolar
Total Conventional
16%
Cumulative Incidence Revision
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Bipolar 1909 1453 1188 1039 814 638 407

a o a .o rg.a u 149
Table HT54 Cumulative Incidence Mortality of Primary Hip Replacement in Patients Aged ≥ 70 Years by Class (Primary

Unipolar Monoblock 36.3 49.1 59.5 74.7 83.4 90.2
Unipolar Modular 24.3 34.8 44.4 60.2 71.4 81.6
Bipolar 21.6 31.5 40.0 54.9 66.4 78.4
Total Conventional 9.3 15.8 22.3 36.3 48.9 64.8
Figure HT60 Cumulative Incidence Mortality of Primary Hip Replacement in Patients Aged ≥ 70 Years by Class (Primary
100%
Unipolar Monoblock
Unipolar Modular
90%
Bipolar
Total Conventional
80%
Cumulative Incidence Mortality
70%
60%
50%
40%
30%
20%
10%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Bipolar 15577 10597 8112 6376 4052 2553 1191

Table HT55 Cumulative Incidence Revision of Primary Hip Replacement in Patients Aged ≥ 70 Years by Class (Primary

Unipolar Monoblock 2.3 (2.1, 2.5) 2.9 (2.7, 3.1) 3.2 (3.0, 3.4) 3.5 (3.2, 3.7) 3.6 (3.4, 3.8) 3.7 (3.5, 3.9)
Unipolar Modular 1.7 (1.6, 1.9) 2.2 (2.1, 2.4) 2.5 (2.3, 2.7) 3.0 (2.8, 3.2) 3.3 (3.1, 3.6) 3.5 (3.3, 3.8)
Bipolar 2.0 (1.8, 2.2) 2.4 (2.2, 2.7) 2.8 (2.5, 3.1) 3.1 (2.8, 3.4) 3.3 (3.0, 3.6) 3.6 (3.3, 3.9)
Total Conventional 2.8 (2.5, 3.1) 3.5 (3.2, 3.9) 3.9 (3.5, 4.3) 4.5 (4.1, 4.9) 4.9 (4.5, 5.4) 5.4 (4.9, 5.9)
Figure HT61 Cumulative Incidence Revision of Primary Hip Replacement in Patients Aged ≥ 70 Years by Class (Primary
20%
Unipolar Monoblock
Unipolar Modular
18%
Bipolar
Total Conventional
16%
Cumulative Incidence Revision
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Bipolar 15577 10597 8112 6376 4052 2553 1191

a o a .o rg.a u 151
PRIMARY TOTAL RESURFACING HIP REPLACEMENT

DEMOGRAPHICS
There have been 16,950 total resurfacing hip There was a small increase in the proportion of
replacement procedures reported to the patients aged less than 55 years receiving
Registry. This is an additional 429 procedures total resurfacing hip replacement in 2016
compared to the last report. (Figure HT63).
The use of total resurfacing hip replacement in

Australia has been declining since 2005. In Figure HT63 Primary Total Resurfacing Hip Replacement
2016, the number of total resurfacing by Age
procedures was 15.0% greater than in 2015
100%
and 77.0% less than in 2005. Total resurfacing <55 55-64
90% 65-74 ≥75
hip replacement represents 2.5% of all hip
replacements performed in 2016. 80%
70%
In 2016, 99.3% of total resurfacing hip
60%
replacements were undertaken in males
50%
(Figure HT62).
40%
30%
Figure HT62 Primary Total Resurfacing Hip Replacement 20%

by Gender
10%
100% 0%
Male
90% Female
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
80%
70%
60%
There were only two different types of
50%
resurfacing prostheses used in 2016, with the
40% Adept the most commonly used, accounting
30% for 61.1% of procedures (Table HT57).
20%
10%
0%
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
Table HT56 Age and Gender of Primary Total Resurfacing Hip Replacement

Male 13371 78.9% 13 93 54 53.4 9.0
Female 3579 21.1% 14 81 53 51.6 8.6
TOTAL 16950 100.0% 13 93 54 53.0 8.9

Table HT57 Most Used Resurfacing Heads in Primary Total Resurfacing Hip Replacement
2003 2013 2014 2015 2016

1359 BHR 267 BHR 286 BHR 196 Adept 258 Adept
58 Durom 126 Adept 94 Adept 171 BHR 164 BHR
43 ASR 5 Icon
42 Cormet 4 Cormet
38 Cormet 2000 HAP
7 Conserve Plus
Most Used
1547 (6) 100.0% 402 (4) 100.0% 380 (2) 100.0% 367 (2) 100.0% 422 (2) 100.0%

a o a .o rg.a u 153

Primary Diagnosis Prosthesis Types
The principal diagnosis for primary total The cumulative percent revision of different
resurfacing hip replacement is osteoarthritis total resurfacing hip prosthesis combinations
(95.3%), followed by developmental dysplasia with more than 100 procedures is listed in Table
(2.3%) and osteonecrosis (1.6%) (Table HT58). HT59. At 10 years, the prosthesis with the lowest
Primary total resurfacing hip replacement for cumulative percent revision is the Mitch TRH
osteoarthritis has a lower rate of revision (5.6%).
compared to developmental dysplasia. There is
no difference in the rate of revision for
osteonecrosis compared to osteoarthritis (Figure
HT64).
Table HT58 Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement by Primary Diagnosis
N N
Revised Total
Osteoarthritis 1424 16155 1.7 (1.5, 1.9) 3.2 (2.9, 3.5) 4.8 (4.5, 5.2) 9.5 (9.0, 10.0) 13.0 (12.2, 13.8) 13.8 (12.5, 15.2)
Developmental Dysplasia 84 394 3.1 (1.7, 5.3) 6.2 (4.2, 9.1) 12.0 (9.1, 15.7) 20.7 (16.8, 25.2)
Osteonecrosis 37 270 2.2 (1.0, 4.9) 4.9 (2.9, 8.3) 7.2 (4.7, 11.1) 10.7 (7.4, 15.2)
Other (6) 20 131 2.3 (0.8, 7.0) 5.6 (2.7, 11.4) 9.9 (5.7, 16.8) 16.3 (10.5, 24.8)
TOTAL 1565 16950
Note: Only primary diagnoses with over 100 procedures have been listed
Figure HT64 Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement by Primary Diagnosis

35%
Osteoarthritis
Developmental Dysplasia
Osteonecrosis Entire Period: HR=1.49 (1.19, 1.87),p<0.001
30%
25%
Developmental Dysplasia vs Osteonecrosis

15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Osteoarthritis 16155 15456 14448 13298 7349 604 76
Developmental Dysplasia 394 378 357 330 225 17 4
Osteonecrosis 270 258 246 237 171 22 6

Table HT59 Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement by Prosthesis Combination
Head Acetabular N N
ASR ASR* 356 1168 3.4 (2.5, 4.6) 7.2 (5.9, 8.8) 15.3 (13.4, 17.5) 30.4 (27.8, 33.3)
Adept Adept 36 1206 0.9 (0.5, 1.7) 1.8 (1.1, 2.9) 2.7 (1.8, 4.2) 7.5 (5.1, 11.1)
BHR BHR 797 11377 1.4 (1.2, 1.6) 2.5 (2.2, 2.8) 3.5 (3.2, 3.9) 6.9 (6.4, 7.4) 10.2 (9.5, 11.1) 11.0 (9.8, 12.4)
Bionik Bionik* 47 200 3.5 (1.7, 7.2) 12.0 (8.2, 17.4) 17.1 (12.5, 23.1)
Cormet Cormet* 113 626 2.1 (1.2, 3.6) 5.6 (4.1, 7.7) 9.5 (7.5, 12.1) 17.7 (14.7, 21.3)
Durom Durom* 93 847 3.2 (2.2, 4.6) 5.4 (4.1, 7.2) 7.5 (5.9, 9.5) 10.9 (8.9, 13.3)
Icon Icon* 13 118 1.7 (0.4, 6.6) 4.2 (1.8, 9.9) 5.9 (2.9, 12.1) 11.6 (6.6, 19.9)
Mitch TRH Mitch TRH* 46 1024 1.2 (0.7, 2.1) 2.1 (1.4, 3.2) 2.6 (1.8, 3.8) 5.6 (4.1, 7.5)
Recap Recap* 27 195 5.1 (2.8, 9.3) 8.7 (5.5, 13.7) 10.3 (6.8, 15.5) 15.8 (10.9, 22.6)
Other (9) 37 189 5.3 (2.9, 9.6) 7.4 (4.5, 12.2) 9.6 (6.1, 14.8) 16.6 (11.9, 22.9)
TOTAL 1565 16950
* denotes prosthesis combinations with no reported use in primary total resurfacing hip replacement in 2016

a o a .o rg.a u 155
OUTCOME FOR OSTEOARTHRITIS

The cumulative percent revision at 16 years for years, for the first six months only. After six
primary total resurfacing hip replacement months, patients aged 65 years or older have a
undertaken for osteoarthritis is 13.8% (Table HT60 lower rate of revision compared to patients
and Figure HT65). aged less than 55 years, and patients aged 55
to 64 years (Table HT63 and Figure HT67).
Reasons for Revision
Females have a higher rate of revision
The main reasons for revision of primary total compared to males. After one year, the rate of
resurfacing hip replacement are metal related revision is over three times higher for females
pathology (28.1%), loosening (23.4%) and compared to males (Table HT64 and Figure
fracture (18.7%) (Table HT61). HT68). Males aged 65 years or older have a
higher rate of revision compared to males
aged less than 55 years, and 55 to 64 years, for
Metal related pathology is the most the first six months only. After six months, the
common reason for revision after seven rate of revision for males aged 65 years or older
years. is lower compared to males aged less than 55
years. After three months, females aged 65
years or older have a lower rate of revision
The five most common reasons for revision are compared to females aged less than 55 years
shown in Figure HT66. The cumulative incidence (Table HT64, Figures HT69 and HT70).
of fracture increases rapidly in the first year.
After this time, the incidence increases at a Head Size
slower rate. The cumulative incidence of metal The rate of revision decreases as the femoral
related pathology continues to increase and component head size increases. Femoral head
becomes the most common reason for revision sizes of 44mm or less, and 45 to 49mm, have
after seven years. over twice the rate of revision compared to
head sizes 55mm or larger. There is no
Type of Revision difference for head sizes 50 to 54mm compared
The most common type of revision for total to 55mm or larger (Table HT65 and Figure HT71).
resurfacing hip replacement is revision of both
the femoral and acetabular components The reason for revision varies with head size.
(70.2%). Femoral only revision is much less Head sizes less than 50mm have a higher
common (23.9%) and acetabular only revision is cumulative incidence of metal related
rarely undertaken (3.0%) (Table HT62). pathology, loosening, fracture, infection, and
lysis compared to head sizes 50mm or larger
(Figure HT72).
Age and Gender
Patients aged 65 years or older have a higher This effect of femoral component head size is
rate of revision compared to patients aged less evident in both males and females (Table HT66
than 55 years, and patients aged 55 to 64 and Figure HT73).

Table HT60 Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement (Primary Diagnosis OA)
N N
Revised Total
Total Resurfacing 1424 16155 1.7 (1.5, 1.9) 3.2 (2.9, 3.5) 4.8 (4.5, 5.2) 9.5 (9.0, 10.0) 13.0 (12.2, 13.8) 13.8 (12.5, 15.2)
TOTAL 1424 16155
Figure HT65 Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement (Primary Diagnosis OA)
35%
Total Resurfacing
30%
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Total Resurfacing 16155 15456 14448 13298 7349 604 76

a o a .o rg.a u 157
Table HT61 Primary Total Resurfacing Hip Replacement by Table HT62 Primary Total Resurfacing Hip Replacement by
Reason for Revision (Primary Diagnosis OA) Type of Revision (Primary Diagnosis OA)

Metal Related Pathology 400 28.1 THR (Femoral/Acetabular) 1000 70.2
Loosening 333 23.4 Femoral Component 341 23.9
Fracture 266 18.7 Acetabular Component 43 3.0
Lysis 125 8.8 Cement Spacer 30 2.1
Pain 89 6.3 TOTAL 1424 100.0
Osteonecrosis 36 2.5
Malposition 20 1.4
Prosthesis Dislocation 20 1.4
Other 42 2.9
TOTAL 1424 100.0
Figure HT66 Cumulative Incidence Revision Diagnosis of Primary Total Resurfacing Hip Replacement (Primary Diagnosis OA)
Total Resurfacing
8.0%
Metal Related Pathology
Loosening
7.0%
Fracture
Lysis
6.0% Infection
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Table HT63 Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement by Age (Primary Diagnosis OA)
N N
Revised Total
<55 783 8522 1.4 (1.2, 1.7) 3.0 (2.7, 3.4) 4.8 (4.4, 5.3) 10.1 (9.4, 10.8) 14.2 (13.1, 15.4) 14.5 (13.2, 15.8)
55-64 535 6189 1.7 (1.4, 2.1) 3.1 (2.7, 3.6) 4.7 (4.2, 5.3) 9.2 (8.4, 10.0) 12.2 (11.0, 13.5)
≥65 106 1444 3.1 (2.4, 4.2) 4.2 (3.2, 5.4) 5.3 (4.2, 6.6) 7.5 (6.2, 9.1) 9.6 (7.7, 11.8)
TOTAL 1424 16155
Figure HT67 Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement by Age (Primary Diagnosis OA)

35%
<55
55-64 vs <55
55-64
≥65 0 - 1.5Yr: HR=1.28 (1.02, 1.61),p=0.030
30%
1.5Yr+: HR=0.86 (0.76, 0.97),p=0.017
≥65 vs <55
25%
0 - 6Mth: HR=3.34 (2.33, 4.81),p<0.001

6Mth+: HR=0.66 (0.51, 0.85),p=0.001
20%
≥65 vs 55-64
0 - 6Mth: HR=2.58 (1.79, 3.72),p<0.001
15%
6Mth+: HR=0.74 (0.57, 0.95),p=0.020
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

<55 8522 8161 7606 6929 3716 332 51
55-64 6189 5940 5581 5182 2917 225 22
≥65 1444 1355 1261 1187 716 47 3

a o a .o rg.a u 159
Table HT64 Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement by Gender and Age (Primary Diagnosis
OA)
N N
Revised Total
Male 785 12893 1.5 (1.3, 1.8) 2.6 (2.3, 2.9) 3.7 (3.3, 4.0) 6.6 (6.1, 7.1) 9.2 (8.5, 10.1) 9.5 (8.6, 10.4)
<55 402 6647 1.2 (1.0, 1.5) 2.4 (2.1, 2.8) 3.4 (3.0, 3.9) 6.7 (6.0, 7.4) 9.9 (8.8, 11.2)
55-64 296 4935 1.6 (1.2, 1.9) 2.5 (2.1, 2.9) 3.6 (3.1, 4.2) 6.5 (5.8, 7.4) 8.6 (7.5, 9.8)
≥65 87 1311 3.1 (2.3, 4.2) 4.0 (3.0, 5.2) 4.9 (3.9, 6.3) 6.8 (5.5, 8.4)
Female 639 3262 2.3 (1.8, 2.9) 5.4 (4.7, 6.2) 9.1 (8.2, 10.1) 18.6 (17.3, 20.1) 24.1 (22.2, 26.2)
<55 381 1875 2.1 (1.6, 2.9) 5.1 (4.2, 6.2) 9.3 (8.1, 10.8) 19.4 (17.6, 21.4) 25.3 (22.8, 28.0)
55-64 239 1254 2.4 (1.7, 3.4) 5.7 (4.5, 7.1) 8.8 (7.4, 10.5) 18.0 (15.9, 20.3) 23.1 (20.1, 26.4)
≥65 19 133 3.8 (1.6, 8.8) 6.0 (3.1, 11.7) 8.4 (4.7, 14.6) 13.5 (8.6, 20.9)
TOTAL 1424 16155
Figure HT68 Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement by Gender (Primary Diagnosis OA)

35%
Male
Female vs Male
Female
0 - 3Mth: HR=2.06 (1.43, 2.95),p<0.001
30%
3Mth - 6Mth: HR=1.21 (0.70, 2.08),p=0.492
6Mth - 1Yr: HR=0.93 (0.51, 1.70),p=0.814
25% 1Yr+: HR=3.19 (2.84, 3.58),p<0.001
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Male 12893 12276 11388 10384 5501 418 55
Female 3262 3180 3060 2914 1848 186 21

Figure HT69 Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement in Males by Age (Primary Diagnosis
OA)
35%
Male <55
Male 55-64 vs Male <55
Male 55-64
Male ≥65 0 - 1Mth: HR=2.35 (1.06, 5.21),p=0.036
30%
1Mth+: HR=0.93 (0.80, 1.08),p=0.331
Male ≥65 vs Male <55

25%
0 - 6Mth: HR=3.08 (2.08, 4.56),p<0.001

6Mth+: HR=0.72 (0.54, 0.96),p=0.027
20%
Male ≥65 vs Male 55-64
0 - 6Mth: HR=2.62 (1.74, 3.95),p<0.001
15%
6Mth+: HR=0.79 (0.58, 1.06),p=0.115
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Male <55 6647 6330 5839 5258 2679 227 35
55-64 4935 4719 4410 4058 2187 152 17
≥65 1311 1227 1139 1068 635 39 3
Figure HT70 Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement in Females by Age (Primary Diagnosis
OA)
35%
Female <55
Female 55-64 vs Female <55
Female 55-64
Female ≥65 Entire Period: HR=0.93 (0.79, 1.09),p=0.388
30%
Female ≥65 vs Female <55
0 - 3Mth: HR=2.26 (0.81, 6.31),p=0.120
25%
3Mth+: HR=0.58 (0.35, 0.98),p=0.040
20% Female ≥65 vs Female 55-64

15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Female <55 1875 1831 1767 1671 1037 105 16
55-64 1254 1221 1171 1124 730 73 5
≥65 133 128 122 119 81 8 0

a o a .o rg.a u 161
Table HT65 Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement by Head Size (Primary Diagnosis OA)
N N
Revised Total
≤44mm 299 1196 3.4 (2.5, 4.6) 8.0 (6.6, 9.7) 12.4 (10.7, 14.5) 23.3 (20.9, 25.9) 30.5 (27.2, 34.0)
45-49mm 505 3699 2.4 (1.9, 2.9) 4.4 (3.8, 5.1) 7.0 (6.2, 7.9) 14.4 (13.2, 15.7) 18.9 (17.1, 20.9)
50-54mm 569 10117 1.3 (1.1, 1.6) 2.3 (2.0, 2.6) 3.3 (2.9, 3.6) 6.1 (5.6, 6.6) 8.7 (7.8, 9.6) 9.0 (8.0, 10.1)
≥55mm 51 1142 1.0 (0.5, 1.7) 1.8 (1.2, 2.8) 2.9 (2.0, 4.1) 5.0 (3.7, 6.6)
TOTAL 1424 16154
Note: Excludes one procedure with unknown head size
Figure HT71 Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement by Head Size (Primary Diagnosis OA)

35%
≤44mm
≤44mm vs ≥55mm
45-49mm
50-54mm Entire Period: HR=3.28 (2.36, 4.55),p<0.001
30%
≥55mm
45-49mm vs ≥55mm
25%
50-54mm vs ≥55mm
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

≤44mm 1196 1153 1092 1030 633 71 7
45-49mm 3699 3548 3335 3093 1661 154 13
50-54mm 10117 9652 9009 8243 4636 349 51
≥55mm 1142 1102 1011 931 419 30 5
Figure HT72 Cumulative Incidence Revision Diagnosis of Primary Total Resurfacing Hip Replacement by Head Size (Primary
Diagnosis OA)
<50mm ≥50mm
10.0% 10.0%
Metal Related Pathology Metal Related Pathology
Loosening Loosening
Fracture Fracture
8.0% Lysis 8.0% Lysis
Infection Infection
6.0% 6.0%
4.0% 4.0%
2.0% 2.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Table HT66 Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement by Gender and Head Size (Primary
Diagnosis OA)
N N
Gender Head Size 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Male 785 12892 1.5 (1.3, 1.8) 2.6 (2.3, 2.9) 3.7 (3.3, 4.0) 6.6 (6.1, 7.1) 9.2 (8.5, 10.1) 9.5 (8.6, 10.4)
<50mm 211 2084 2.7 (2.1, 3.5) 4.3 (3.5, 5.2) 6.0 (5.0, 7.1) 11.2 (9.8, 12.9) 15.1 (12.9, 17.6)
≥50mm 574 10808 1.3 (1.1, 1.5) 2.3 (2.0, 2.6) 3.2 (2.9, 3.6) 5.7 (5.3, 6.3) 8.2 (7.4, 9.0) 8.5 (7.5, 9.5)
Female 639 3262 2.3 (1.8, 2.9) 5.4 (4.7, 6.2) 9.1 (8.2, 10.1) 18.6 (17.3, 20.1) 24.1 (22.2, 26.2)
<50mm 593 2811 2.6 (2.1, 3.3) 6.0 (5.2, 7.0) 10.0 (8.9, 11.2) 20.0 (18.5, 21.6) 25.9 (23.9, 28.2)
≥50mm 46 451 0.4 (0.1, 1.8) 1.3 (0.6, 2.9) 3.6 (2.2, 5.8) 10.0 (7.4, 13.3)
TOTAL 1424 16154
Note: Excludes one male procedure with unknown head size
Figure HT73 Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement by Gender and Head Size (Primary
Diagnosis OA)

35%
Male <50mm
Male <50mm vs Male ≥50mm
Male ≥50mm
Female <50mm Entire Period: HR=2.01 (1.72, 2.35),p<0.001
30%
Female ≥50mm
Male ≥50mm vs Female ≥50mm
0 - 3Yr: HR=1.69 (0.75, 3.79),p=0.204
25%
3Yr - 4.5Yr: HR=0.60 (0.24, 1.47),p=0.260

4.5Yr - 5Yr: HR=0.23 (0.09, 0.60),p=0.002
20% 5Yr+: HR=0.51 (0.35, 0.74),p<0.001
Male <50mm vs Female <50mm

15%
Female <50mm vs Female ≥50mm

10%
0 - 4.5Yr: HR=4.01 (2.20, 7.30),p<0.001
4.5Yr - 5Yr: HR=0.81 (0.32, 2.03),p=0.658
5% 5Yr+: HR=1.90 (1.31, 2.75),p<0.001
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Male <50mm 2084 1970 1808 1636 746 68 3
≥50mm 10808 10305 9579 8747 4755 350 52
Female <50mm 2811 2731 2619 2487 1548 157 17
≥50mm 451 449 441 427 300 29 4

a o a .o rg.a u 163
Knee Replacement
Knee Replacement
CATEGORIES OF KNEE REPLACEMENT
The Registry groups knee replacement into Revision knee replacements are re-operations
three broad categories: primary partial, primary of previous knee replacements where one or
total and revision knee replacement. more of the prosthetic components are
replaced, removed, or one or more
A primary replacement is an initial replacement components are added. Revisions include re-
procedure undertaken on a joint and involves operations of primary partial, primary total or
replacing either part (partial) or all (total) of the previous revision procedures. Knee revisions are
articular surface. sub-categorised into three classes: major total,
major partial, or minor revisions.
Primary partial knees are sub-categorised into
classes depending on the type of prosthesis Detailed demographic information on knee replacement is
available in the supplementary report ‘Demographics of Hip, Knee
used. The classes of primary partial knee and Shoulder Arthroplasty’ on the AOANJRR website:
replacement are: partial resurfacing, unispacer, https://aoanjrr.sahmri.com/annual-reports-2017
bicompartmental, patella/trochlea and

unicompartmental. These are defined in the
subsequent sections.
KNEE REPLACEMENT
PARTIAL
RESURFACING
MAJOR
TOTAL
UNISPACER
MAJOR
BICOMPARTMENTAL TOTAL
PARTIAL
PATELLA/TROCHLEA
MINOR
UNICOMPARTMENTAL

a o a .o rg.a u 165
USE OF KNEE REPLACEMENT

This report analyses 653,480 knee replacements In 2016, primary total knee replacement
with a procedure date up to and including 31 accounts for 87.0% of all knee replacement
December 2016. This is an additional 60,903 procedures. This has increased from 76.7% in
knee procedures compared to the number 2003. Primary partial knee replacement
reported last year. When considering all knee decreased from 15.1% in 2003 to 5.6% in 2016.
procedures currently recorded by the Registry, The proportion of revision knee procedures has
primary partial knee accounts for 8.1%, primary declined from a peak of 8.8% in 2004 to 7.4% in
total knee 83.8% and revision knee 2016. This equates to 834 fewer revision
replacement 8.1% (Table K1). procedures in 2016 than would have been
expected if the proportion of revision
procedures had remained at 8.8% (Figure K1).
Table K1 Number of Knee Replacements
Knee Category Number Percent

Partial 52902 8.1 Figure K1 Proportion of Knee Replacements
Total 547407 83.8 100%
Partial
Revision 53171 8.1 Total
90%
TOTAL 653480 100.0 Revision
80%
70%
In 2016, the number of knee replacements 60%

undertaken increased by 2,020 (3.5%) 50%
compared to 2015. During the last year, primary
40%
partial and primary total knee replacement
increased by 18.8% and 2.8%, respectively. 30%
There was a slight increase in revision knee 20%

0%
Since 2003, the number of knee replacement
03
04
05
06
07
08
09
10
11
12
13
14
15
16
procedures undertaken annually has increased
20
20
20
20
20
20
20
20
20
20
20
20
20
20
by 111.5%. Primary total knee replacement has
increased by 139.8% and revision knee
replacement by 92.1%. Primary partial knee
replacement has decreased by 22.0%.

ASA SCORE AND BMI IN KNEE REPLACEMENT

Data is reported on knee replacement Overall, in 92.2% of procedures, patients have
procedures for both the American Society of an ASA score of 2 or 3, 6.5% have a score of 1
Anaesthesiologists - Physical Status Classification and 1.3% have a score of 4. Very few
(ASA score) and Body Mass Index (BMI). The procedures were recorded where patients
Registry commenced collecting ASA score in have a score of 5.
2012 and BMI in 2015.
There is a difference depending on the class of
There is ASA score data on 206,077 and BMI knee replacement. There are more patients
data on 103,566 knee replacement undergoing partial knee replacement
procedures. procedures with ASA scores 1 or 2 than those
having primary total knee replacement
In 2016, the ASA score is reported in 99.3% of procedures (76.1% and 62.7%, respectively). For
knee replacement procedures and BMI is patients undergoing revision knee replacement
reported in 92.3% of procedures. surgery, there are a lower proportion with ASA
scores 1 or 2 (50.8%) (Table K2).
BMI is reported for 93.1% of primary partial
BMI
knees, 92.7% of primary total knees and 87.5%
of revision knee replacements. BMI for adults is classified by the World Health
Organisation into six main categories
ASA score and BMI are both known to impact (http://apps.who.int/bmi/index.jsp?introPage=i
the outcome of knee replacement surgery. In ntro_3.html):
the future, this data will be used to risk adjust in 1. Underweight <18.50
a range of analyses. 2. Normal 18.50 - 24.99
3. Pre-obese 25.00 - 29.99
4. Obese Class 1 30.00 - 34.99
ASA SCORE
5. Obese Class 2 35.00 - 39.99
There are five ASA score classifications 6. Obese Class 3 ≥40.00
(https://www.asahq.org/resources/clinical-
information/asa-physical-status-classification- For all knee replacements, the majority of
system): procedures are undertaken in patients that are
1. A normal healthy patient. either pre-obese or obese class 1 (62.3%). There
2. A patient with mild systemic disease. is almost no difference in BMI for patients when
3. A patient with severe systemic disease. primary total and revision knee replacement
4. A patient with severe systemic disease are compared. For partial knee replacement,
that is a constant threat to life. 55.6% of procedures were in either normal or
5. A moribund patient who is not pre-obese patients compared to 41.8% for
expected to survive without the primary total knee and 41.3% for revision knee
operation. replacement (Table K3).
There is a gender difference with a higher

proportion of males in the normal and pre-
obese categories, which is most apparent in
primary partial knee replacement (Figure K2).

a o a .o rg.a u 167
Table K2 ASA Score by Knee Category

1 1482 14.4 11240 6.2 668 4.2 13390 6.5
2 6367 61.7 101706 56.5 7363 46.6 115436 56.0
3 2415 23.4 64927 36.1 7215 45.6 74557 36.2
4 47 0.5 2068 1.1 565 3.6 2680 1.3
5 1 0.0 11 0.0 2 0.0 14 0.0
TOTAL 10312 100.0 179952 100.0 15813 100.0 206077 100.0
Table K3 BMI Category for Knee Replacement by Knee Category

Underweight 8 0.1 192 0.2 26 0.4 226 0.2
Normal 827 15.0 9643 10.6 818 11.0 11288 10.9
Pre-obese 2242 40.6 28311 31.2 2248 30.3 32801 31.7
Obese Class 1 1653 29.9 27720 30.6 2288 30.8 31661 30.6
Obese Class 2 582 10.5 15234 16.8 1270 17.1 17086 16.5
Obese Class 3 210 3.8 9526 10.5 768 10.4 10504 10.1
TOTAL 5522 100.0 90626 100.0 7418 100.0 103566 100.0
Figure K2 BMI Distribution by Gender and Knee Category

Primary Partial Knee Replacement

CLASSES OF PARTIAL KNEE REPLACEMENT USE OF PARTIAL KNEE REPLACEMENT
The Registry sub-categorises partial knee Unicompartmental knee replacement remains
replacement into five classes. These are the most common primary partial knee
defined by the type of prostheses used. replacement, accounting for 93.0% of all partial
knee replacement procedures. The second
1. Partial resurfacing involves the use of one most common is patella/trochlea replacement
or more button prostheses to replace part (6.2%). Only small numbers of the three
of the natural articulating surface on one remaining partial knee procedures have been
or more sides of the joint, in one or more reported (partial resurfacing, unispacer and
articular compartments of the knee. bicompartmental knee replacement) (Table
2. Unispacer involves the use of a medial or KP1).
lateral femorotibial compartment articular
spacer. The unispacer procedure has not been used
3. Bicompartmental involves the replacement since 2005 and has the highest revision rate of
of the medial femoral and trochlear any class of partial knee replacement.
articular surface of the knee with a single Bicompartmental knee replacement has not
femoral prosthesis, as well as the medial been used since 2012. Neither of these classes
tibial articular surface with a of partial knee replacement are presented in
unicompartmental tibial prosthesis. It may detail in this report.
also include the use of a patellar prosthesis.
4. Patella/trochlea involves the use of a Detailed information on unispacer and bicompartmental knee
replacement is available in the supplementary report ‘Outcomes of
trochlear prosthesis to replace the femoral Classes No Longer Used - Hip and Knee Arthroplasty’ on the
trochlear articular surface and on most AOANJRR website: https://aoanjrr.sahmri.com/annual-reports-2017.
occasions a patellar prosthesis.

5. Unicompartmental involves the Osteoarthritis is the principal diagnosis for the
replacement of the femoral and tibial five classes of partial knee replacement
articular surface of either the medial or (98.9%). There is considerable variation in the
lateral femorotibial compartment using outcome of primary partial knee replacement
unicompartmental femoral and tibial depending on the class (Table KP2).
prostheses.
Table KP1 Partial Knee Replacement by Class
Partial Knee Class Number Percent

Detailed information on demographics of each class of primary
partial knee replacement is available in the supplementary report
‘Demographics of Hip, Knee and Shoulder Arthroplasty’ on the Partial Resurfacing 238 0.4
AOANJRR website https://aoanjrr.sahmri.com/annual-reports-2017
Unispacer 40 0.1
Bicompartmental 165 0.3
Patella/Trochlea 3286 6.2
Unicompartmental 49173 93.0
TOTAL 52902 100.0
Table KP2 Cumulative Percent Revision of Primary Partial Knee Replacement by Class
N N
Partial Knee Class 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Partial Resurfacing 70 238 5.5 (3.3, 9.3) 17.0 (12.7, 22.5) 25.0 (19.6, 31.5)
Unispacer 32 40 42.5 (29.0, 59.2) 67.5 (53.0, 81.2) 67.5 (53.0, 81.2) 77.5 (63.7, 88.8)
Bicompartmental 24 165 6.1 (3.3, 11.0) 11.7 (7.6, 17.7) 14.2 (9.7, 20.6)
Patella/Trochlear 604 3286 2.5 (2.0, 3.1) 8.6 (7.6, 9.7) 14.5 (13.2, 16.0) 27.7 (25.5, 30.0) 44.5 (39.6, 49.8)
Unicompartmental 5964 49173 2.2 (2.1, 2.4) 5.7 (5.5, 5.9) 8.1 (7.8, 8.4) 14.7 (14.3, 15.1) 22.1 (21.4, 22.9) 23.4 (22.4, 24.4)
TOTAL 6694 52902

a o a .o rg.a u 169
PARTIAL RESURFACING
DEMOGRAPHICS
The Registry has recorded 238 partial There are 85 procedures that involve
resurfacing knee procedures. This is an resurfacing of the patella/trochlear joint either
additional 14 procedures compared to the on one side (27) or both sides (58). This is six
number reported last year. The use of partial more patella/trochlear procedures than
resurfacing knee replacement has decreased reported last year. The five year cumulative
from a peak of 42 procedures in 2006. percent revision for one side is 22.4% and 35.5%
when both sides were resurfaced.
The most common reason for undertaking a
partial resurfacing procedure is osteoarthritis The main reasons for revision of a partial
(88.7%). The mean age of patients with partial resurfacing are progression of disease (60.0%),
resurfacing knee replacement was 50.4 years loosening (12.9%) and pain (8.6%).
and 50.8% were males (Table KP3).
Most primary partial resurfacing replacements
All recorded partial resurfacing procedures are revised to either a total knee replacement
used the ‘Hemicap’ range of prostheses. (54.3%) or unicompartmental knee
replacement (25.7%). The remaining revisions
Of the 238 procedures, 177 used one cap, 56 are patellar resurfacing only (7.1%),
used two, and five used three caps. When a patella/trochlear resurfacing (5.7%), partial
single cap was used, most (138) were resurfacing (5.7%), or removal of the prosthesis
implanted on the femoral articular surface. The (1.4%).
remainder were used on the trochlear (14),
tibial (13) and patellar surfaces (10). There are The cumulative percent revision of partial
two procedures where the positioning of the resurfacing procedures undertaken for
cap is unknown. When two caps were used, 53 osteoarthritis is 5.8% at one year and 38.7% at
were implanted on the patellar plus trochlear, nine years (Table KP4 and Figure KP1).
one patellar plus femoral, and two where both
devices were used on the femoral articular
surface. The five procedures using three caps
were all implanted on the patellar, trochlear The cumulative percent revision of partial
and femoral articular surfaces. resurfacing procedures undertaken for
osteoarthritis is 38.7% at nine years.
Table KP3 Age and Gender of Primary Partial Resurfacing Knee Replacement

Male 121 50.8% 17 85 49 49.3 14.3
Female 117 49.2% 30 88 51 51.5 11.7
TOTAL 238 100.0% 17 88 50 50.4 13.1

Table KP4 Cumulative Percent Revision of Primary Partial Resurfacing Knee Replacement (Primary Diagnosis OA)
N N
Knee Class 1 Yr 2 Yrs 3 Yrs 5 Yrs 7 Yrs 9 Yrs
Revised Total
Partial Resurfacing 67 211 5.8 (3.3, 10.0) 16.6 (12.2, 22.5) 18.3 (13.6, 24.3) 27.5 (21.5, 34.7) 36.2 (29.3, 44.1) 38.7 (31.6, 46.9)
TOTAL 67 211
Figure KP1 Cumulative Percent Revision of Primary Partial Resurfacing Knee Replacement (Primary Diagnosis OA)
50%
Partial Resurfacing
40%
30%
20%
10%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Partial Resurfacing 211 194 162 144 103 83 52

a o a .o rg.a u 171
PATELLA/TROCHLEA
DEMOGRAPHICS Figure KP3 Primary Patella/Trochlea Knee Replacement by
Age
There have been 3,286 patella/trochlear knee
100%
replacements reported to the Registry. This is an <55 55-64
additional 305 procedures compared to the 90% 65-74 75-84
≥85
previous report. 80%
70%
The principal diagnosis for patella/trochlear
procedures is osteoarthritis (98.9%). This 60%
procedure is most frequently undertaken in 50%

females (76.9%). The mean age of patients is 40%
58.9 years (Table KP5, Figures KP2 and KP3).
30%
20%
Figure KP2 Primary Patella/Trochlea Knee Replacement by
Gender 10%
0%
100%
Male
03
04
05
06
07
08
09
10
11
12
13
14
15
16
Female
20
20
20
20
20
20
20
20
20
20
20
20
20
20
90%
80%
70%
60% In 2016, the four most common resurfacing

trochlear prostheses were the Gender Solutions,
50%
Journey, Restoris MCK and Avon. The Gender
40% Solutions prosthesis was first reported in 2009
30% and since 2010 it has remained the most
20% frequently used prosthesis in this class (Table
KP6).
10%
0% The outcomes of patella/trochlear prosthesis

combinations with more than 20 procedures
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
are presented in Table KP7.
Table KP5 Age and Gender of Primary Patella/Trochlea Knee Replacement

Male 759 23.1% 25 95 60 60.9 13.2
Female 2527 76.9% 22 95 57 58.3 12.0
TOTAL 3286 100.0% 22 95 58 58.9 12.3
Table KP6 Most Used Resurfacing Trochlear Prostheses in Primary Patella/Trochlea Knee Replacement
2003 2013 2014 2015 2016

56 LCS 94 Gender Solutions 115 Gender Solutions 115 Gender Solutions 150 Gender Solutions
43 Avon 47 RBK 41 Avon 39 RBK 38 Journey
29 Lubinus 42 Journey 37 RBK 38 Journey 37 Restoris MCK
13 Themis 26 Avon 32 Journey 37 Avon 35 Avon
9 MOD III 20 Sigma HP 7 Sigma HP 7 Sigma HP 34 RBK
1 RBK 14 Vanguard 1 HLS Kneetec 5 Restoris MCK 6 Sigma HP
3 HLS Kneetec 1 Vanguard 2 Vanguard
Most Used
151 (6) 100.0% 246 (7) 100.0% 234 (7) 100.0% 243 (7) 100.0% 300 (6) 100.0%

Table KP7 Cumulative Percent Revision of Primary Patella/Trochlea Knee Replacement by Prosthesis Combination
Resurfacing N N
Patella 1 Yr 3 Yrs 5 Yrs 10 Yrs 13 Yrs 14 Yrs
Trochlea Revised Total
Avon Avon 57 363 1.2 (0.4, 3.1) 6.9 (4.6, 10.4) 12.5 (9.2, 16.9) 25.1 (19.3, 32.3)
Kinemax
Avon 83 307 2.0 (0.9, 4.3) 4.9 (3.0, 8.0) 11.9 (8.7, 16.1) 22.9 (18.4, 28.3) 31.7 (25.8, 38.5) 34.4 (27.8, 42.1)
Plus*
Avon Triathlon 1 76 0.0 (0.0, 0.0) 1.8 (0.2, 11.8)
Gender Natural Knee
5 33 0.0 (0.0, 0.0) 12.6 (4.2, 34.6) 12.6 (4.2, 34.6)
Solutions Flex
Gender
Nexgen 42 719 1.5 (0.8, 2.8) 5.2 (3.6, 7.6) 7.6 (5.3, 10.9)
Solutions
Journey Genesis II 54 436 2.2 (1.2, 4.2) 8.1 (5.7, 11.4) 12.8 (9.6, 16.9)
LCS LCS* 150 395 3.5 (2.1, 5.9) 11.7 (8.9, 15.3) 20.9 (17.2, 25.3) 37.8 (32.9, 43.3)
Lubinus Duracon* 24 77 2.6 (0.7, 10.0) 9.2 (4.5, 18.4) 16.0 (9.4, 26.4) 25.3 (16.6, 37.2) 36.9 (25.6, 51.3)
Lubinus Lubinus* 19 39 5.1 (1.3, 19.0) 18.1 (9.1, 34.3) 20.9 (11.0, 37.6) 35.2 (22.1, 52.9) 49.9 (34.1, 68.3) 59.0 (41.7, 77.1)
MOD III MOD III* 22 63 4.8 (1.6, 14.0) 14.3 (7.7, 25.7) 17.5 (10.1, 29.4) 26.2 (16.9, 39.2) 39.8 (27.9, 54.5) 39.8 (27.9, 54.5)
RBK RBK 81 477 3.5 (2.2, 5.6) 10.3 (7.7, 13.7) 17.0 (13.5, 21.3) 26.2 (20.9, 32.6)
Restoris MCK Restoris MCK 0 37 0.0 (0.0, 0.0)
Sigma HP PFC Sigma 20 108 4.8 (2.0, 11.1) 15.6 (9.7, 24.6)
Themis Themis* 11 38 2.6 (0.4, 17.2) 2.6 (0.4, 17.2) 8.0 (2.6, 22.7) 18.9 (9.5, 35.6) 36.1 (20.4, 58.4)
Vanguard Series A* 11 41 4.9 (1.2, 18.1) 17.3 (8.6, 32.9) 30.3 (17.0, 50.5)
Other (26) 24 77 4.0 (1.3, 12.0) 13.8 (7.7, 24.2) 16.9 (10.0, 27.9) 38.7 (26.5, 54.1) 47.5 (32.8, 64.8)
TOTAL 604 3286

* denotes prosthesis combination with no reported use in patella/trochlear knee replacement in 2016

a o a .o rg.a u 173

The Registry has recorded 595 revisions of Age and gender are risk factors for revision.
primary patella/trochlear knee replacement for Patients younger than 65 years of age have a
osteoarthritis. higher rate of revision than patients aged 65
years or older (Table KP11 and Figure KP5).
The most common reason for revision is
progression of disease (47.9%), followed by Males have a higher rate of revision than
loosening (16.5%) and pain (12.3%) (Table KP8). females (Table KP12 and Figure KP6).
The main type of revision of a primary

patella/trochlear knee replacement is to a total
knee replacement (84.7%) (Table KP9).
The cumulative percent revision for primary

patella/trochlear knee replacement
undertaken for osteoarthritis is 14.5% at five
years and 41.0% at 14 years (Table KP10 and
Figure KP4).
Table KP8 Primary Patella/Trochlea Knee Replacement by Table KP9 Primary Patella/Trochlea Knee Replacement by
Reason for Revision (Primary Diagnosis OA) Type of Revision (Primary Diagnosis OA)

Progression Of Disease 285 47.9 TKR (Tibial/Femoral) 504 84.7
Loosening 98 16.5 Patella Only 56 9.4
Pain 73 12.3 Patella/Trochlea Resurfacing 24 4.0
Implant Breakage Patella 23 3.9 UKR (Uni Tibial/Uni Femoral) 7 1.2
Wear Patella 19 3.2 Removal of Prostheses 2 0.3
Infection 16 2.7 Cement Spacer 2 0.3
Malalignment 15 2.5 TOTAL 595 100.0
Lysis 10 1.7
Other 56 9.4
TOTAL 595 100.0

Table KP10 Cumulative Percent Revision of Primary Patella/Trochlea Knee Replacement (Primary Diagnosis OA)
N N
Revised Total
Patella/Trochlear 595 3251 2.5 (2.0, 3.1) 8.6 (7.6, 9.7) 14.5 (13.2, 16.0) 27.6 (25.4, 29.9) 38.5 (35.0, 42.2) 41.0 (37.0, 45.2)
TOTAL 595 3251
Figure KP4 Cumulative Percent Revision of Primary Patella/Trochlea Knee Replacement (Primary Diagnosis OA)
50%
Patella/Trochlear
40%
30%
20%
10%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Patella/Trochlear 3251 2874 2220 1650 524 153 83

a o a .o rg.a u 175
Table KP11 Cumulative Percent Revision of Primary Patella/Trochlea Knee Replacement by Age (Primary Diagnosis OA)
N N
Revised Total
<65 453 2231 2.5 (1.9, 3.3) 9.0 (7.8, 10.4) 15.2 (13.5, 16.9) 30.7 (28.0, 33.7) 42.4 (38.2, 46.7) 44.3 (39.8, 49.1)
≥65 142 1020 2.5 (1.7, 3.7) 7.5 (6.0, 9.5) 13.1 (10.9, 15.7) 19.9 (16.8, 23.6) 27.8 (22.3, 34.2)
TOTAL 595 3251
Figure KP5 Cumulative Percent Revision of Primary Patella/Trochlea Knee Replacement by Age (Primary Diagnosis OA)

50%
<65
<65 vs ≥65
≥65
40%
30%
20%
10%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

<65 2231 1965 1534 1134 370 113 65
≥65 1020 909 686 516 154 40 18

Table KP12 Cumulative Percent Revision of Primary Patella/Trochlea Knee Replacement by Gender (Primary Diagnosis OA)
N N
Revised Total
Male 159 752 3.3 (2.2, 4.9) 10.5 (8.4, 13.2) 17.6 (14.7, 21.0) 31.3 (26.7, 36.4)
Female 436 2499 2.2 (1.7, 2.9) 8.0 (6.9, 9.2) 13.6 (12.1, 15.2) 26.5 (24.1, 29.1) 35.9 (32.2, 39.9) 39.2 (34.8, 44.0)
TOTAL 595 3251
Figure KP6 Cumulative Percent Revision of Primary Patella/Trochlea Knee Replacement by Gender (Primary Diagnosis OA)

50%
Male
Male vs Female
Female
40%
30%
20%
10%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Male 752 653 502 373 105 29 18
Female 2499 2221 1718 1277 419 124 65

a o a .o rg.a u 177
UNICOMPARTMENTAL
DEMOGRAPHICS
Unicompartmental knee replacement is most
This year, the Registry is reporting on 49,173
frequently undertaken in patients aged
primary unicompartmental knee procedures.
between 55 and 74 years (66.2%). The age
This is an additional 3,079 procedures
distribution has remained relatively stable since
compared to the last report.
2003 (Figure KP8). The mean age of patients is
65.2 years (Table KP13).
The use of unicompartmental knee
replacement increased from 4.4% of all knee
replacements in 2015 to 5.1% in 2016. Although
the proportion of unicompartmental knee Figure KP8 Primary Unicompartmental Knee Replacement
by Age
replacement has increased slightly over the last
two years, it is still considerably less than it was 100%
<55 55-64
in 2003 (14.5%). 65-74 75-84
90%
≥85
Osteoarthritis is the principal diagnosis, 80%
accounting for 99.0% of primary 70%

unicompartmental knee replacement 60%
procedures.
50%
This procedure is undertaken more often in 40%
males (52.9%) (Table KP13). The proportion of 30%

males has increased from 50.3% in 2007 to 57.4% 20%
in 2016 (Figure KP7).
10%
0%
03
04
05
06
07
08
09
10
11
12
13
14
15
16
Figure KP7 Primary Unicompartmental Knee Replacement
20
20
20
20
20
20
20
20
20
20
20
20
20
20
by Gender
100%
Male
90% Female
In 2016, the 10 most used tibial prostheses
80% accounted for 97.3% of all unicompartmental
70%
procedures. The Oxford (cementless), ZUK and
Restoris MCK were the most used prostheses in
60%
2016 (Table KP14).
50%
40% The outcomes of unicompartmental knee

prosthesis combinations with more than 200
30%
procedures are presented in Table KP15.
20%
10%
0%
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
Table KP13 Age and Gender of Primary Unicompartmental Knee Replacement

Male 26020 52.9% 24 98 65 65.7 9.6
Female 23153 47.1% 25 95 64 64.7 10.2
TOTAL 49173 100.0% 24 98 65 65.2 9.9

Table KP14 10 Most Used Tibial Prostheses in Primary Unicompartmental Knee Replacement
2003 2013 2014 2015 2016

1366 Oxford (ctd) 579 ZUK 674 ZUK 745 ZUK 780 Oxford (cless)
444 Repicci II 483 Oxford (cless) 639 Oxford (cless) 704 Oxford (cless) 730 ZUK
373 Preservation Fixed 398 Oxford (ctd) 397 Oxford (ctd) 394 Oxford (ctd) 607 Restoris MCK
353 M/G 167 Unix 130 Sigma HP 145 Restoris MCK 379 Oxford (ctd)
336 Allegretto Uni 96 Sigma HP 97 Unix 128 Sigma HP 156 Sigma HP
321 GRU 68 Repicci II 52 Journey Uni 113 Unix 133 Journey Uni
Freedom
275 Genesis 64 Journey Uni 51 54 Triathlon PKR 62 Unix
PKR/Active
260 Unix 63 Freedom PKR/Active 47 Endo-Model Sled 46 GRU 40 Endo-Model Sled
Preservation
121 37 Endo-Model Sled 35 Repicci II 46 Repicci II 40 Triathlon PKR
Mobile
101 Endo-Model Sled 36 BalanSys Uni Fixed 28 BalanSys Uni Fixed 41 Journey Uni 18 GMK-UNI
10 Most Used
3950 (10) 96.1% 1991 (10) 93.1% 2150 (10) 94.8% 2416 (10) 94.7% 2945 (10) 97.3%
Remainder
159 (7) 3.9% 147 (10) 6.9% 119 (10) 5.2% 136 (10) 5.3% 83 (8) 2.7%
TOTAL
4109 (17) 100.0% 2138 (20) 100.0% 2269 (20) 100.0% 2552 (20) 100.0% 3028 (18) 100.0%

a o a .o rg.a u 179
Table KP15 Cumulative Percent Revision of Primary Unicompartmental Knee Replacement by Prosthesis Combination
N N
Uni Femoral Uni Tibial 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Allegretto Allegretto
324 2035 3.2 (2.5, 4.0) 5.8 (4.9, 6.9) 8.1 (6.9, 9.3) 14.5 (13.0, 16.3) 21.4 (19.0, 24.0) 23.5 (20.3, 27.1)
Uni Uni*
BalanSys BalanSys
21 388 1.8 (0.9, 3.8) 3.0 (1.7, 5.3) 4.0 (2.4, 6.8) 8.1 (5.2, 12.7)
Uni Uni Fixed
Endo-Model Endo-Model
153 1229 1.1 (0.6, 1.9) 4.8 (3.7, 6.2) 7.6 (6.2, 9.3) 14.4 (12.2, 16.9)
Sled Sled
Freedom Freedom
296 1500 1.7 (1.1, 2.5) 7.4 (6.2, 8.9) 12.8 (11.1, 14.7) 24.8 (22.3, 27.6)
PKR/Active PKR/Active
GRU GRU 252 2050 1.4 (1.0, 2.0) 4.4 (3.6, 5.4) 6.1 (5.1, 7.3) 13.1 (11.5, 14.8)
Genesis Genesis* 309 1864 2.7 (2.0, 3.5) 8.3 (7.1, 9.6) 11.0 (9.6, 12.5) 16.3 (14.6, 18.1)
Journey Journey 18 243 1.3 (0.4, 4.0) 6.3 (3.8, 10.4) 8.7 (5.6, 13.6)
Journey Journey Uni 10 322 3.5 (1.8, 7.0) 4.9 (2.6, 9.2)
M/G M/G* 258 2135 1.6 (1.1, 2.2) 4.2 (3.4, 5.1) 6.4 (5.5, 7.6) 10.7 (9.4, 12.1) 15.5 (13.6, 17.6)
Oxford Oxford
236 4209 3.1 (2.6, 3.7) 5.1 (4.4, 5.9) 6.8 (5.9, 7.8) 13.2 (10.3, 16.7)
(cless) (cless)
Oxford
Oxford (ctd) 21 329 3.5 (1.9, 6.5) 7.9 (4.9, 12.8) 11.4 (7.1, 18.1)
(cless)
Oxford (ctd) Oxford (ctd) 1807 12811 2.2 (1.9, 2.4) 5.8 (5.4, 6.2) 8.4 (7.9, 8.9) 14.7 (14.0, 15.4) 22.4 (21.2, 23.6) 23.1 (21.7, 24.7)
Preservation
Preservation 382 2318 2.4 (1.9, 3.1) 7.1 (6.1, 8.2) 9.5 (8.4, 10.8) 15.6 (14.1, 17.2) 22.8 (19.8, 26.1)
Fixed*
Preservation
Preservation 126 400 5.3 (3.5, 7.9) 15.5 (12.3, 19.5) 19.1 (15.6, 23.3) 27.2 (23.1, 31.9)
Mobile*
Repicci II Repicci II 572 3045 1.7 (1.3, 2.2) 4.8 (4.1, 5.6) 7.9 (7.0, 8.9) 17.7 (16.2, 19.3) 28.6 (26.2, 31.2)
Restoris Restoris
5 752 0.8 (0.3, 1.9)
MCK MCK
Sigma HP Sigma HP 27 857 0.9 (0.4, 1.9) 3.0 (1.9, 4.7) 4.4 (3.0, 6.6)
Triathlon Triathlon
16 224 3.0 (1.4, 6.6) 7.8 (4.5, 13.3) 9.5 (5.4, 16.4)
PKR PKR
Uniglide Uniglide 137 751 4.9 (3.5, 6.7) 10.6 (8.6, 13.1) 12.8 (10.6, 15.5) 19.8 (16.9, 23.2)
Unix Unix 411 3862 2.4 (2.0, 2.9) 5.3 (4.6, 6.1) 7.0 (6.2, 7.9) 12.1 (10.9, 13.3) 18.6 (16.1, 21.4)
ZUK ZUK 275 5921 1.4 (1.1, 1.7) 3.6 (3.1, 4.2) 4.9 (4.3, 5.6) 8.9 (7.6, 10.3)
Other (36) 308 1928 3.8 (3.0, 4.8) 8.6 (7.4, 9.9) 11.1 (9.8, 12.7) 19.7 (17.7, 22.0) 24.1 (21.3, 27.1)
TOTAL 5964 49173
* denotes prosthesis combination with no reported use in unicompartmental knee replacement in 2016


The Registry has recorded 5,894 revisions of Females have a higher rate of revision. The
primary unicompartmental knee replacements. effect of age on the rate of revision is evident in
both males and females (Table KP20 and Figure
The cumulative percent revision at 16 years for KP12).
primary unicompartmental knee replacement
undertaken for osteoarthritis is 23.4% (Table KP16 Comparison of Medial and Lateral
and Figure KP9). Unicompartmental Knee Replacement
The Registry has recorded 1,992 lateral
The main reasons for revision are loosening
unicompartmental knee procedures
(39.9%), progression of disease (31.3%) and pain
undertaken for osteoarthritis. There is no
(8.9%) (Table KP17 and Figure KP10). The main
difference in the rate of revision when
type of revision is to a total knee replacement
compared to medial unicompartmental knee
(87.0%) (Table KP18).
replacement (Table KP21 and Figure KP13).
Age is a major factor affecting the outcome of
The outcome of prosthesis combinations with
primary unicompartmental knee replacement,
more than 50 procedures used in lateral
with the rate of revision decreasing with
unicompartmental knee replacement is
increasing age (Table KP19 and Figure KP11).
presented in Table KP22.
Table KP16 Cumulative Percent Revision of Primary Unicompartmental Knee Replacement (Primary Diagnosis OA)
N N
Revised Total
Unicompartmental 5894 48661 2.2 (2.1, 2.4) 5.7 (5.5, 5.9) 8.1 (7.8, 8.4) 14.6 (14.3, 15.0) 22.1 (21.4, 22.9) 23.4 (22.4, 24.5)
TOTAL 5894 48661
Figure KP9 Cumulative Percent Revision of Primary Unicompartmental Knee Replacement (Primary Diagnosis OA)
40%
Unicompartmental
35%
30%
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Unicompartmental 48661 44448 37673 31992 15639 1471 291

a o a .o rg.a u 181
Table KP17 Primary Unicompartmental Knee Table KP18 Primary Unicompartmental Knee Replacement
Replacement by Reason for Revision (Primary by Type of Revision (Primary Diagnosis OA)
Diagnosis OA)

Loosening 2352 39.9 TKR (Tibial/Femoral) 5126 87.0
Progression Of Disease 1844 31.3 Uni Insert Only 343 5.8
Pain 524 8.9 Uni Tibial Component 207 3.5
Infection 232 3.9 Uni Femoral Component 69 1.2
Lysis 147 2.5 UKR (Uni Tibial/Uni Femoral) 64 1.1
Fracture 136 2.3 Cement Spacer 50 0.8
Bearing Dislocation 117 2.0 Patella/Trochlear Resurfacing 10 0.2
Wear Tibial Insert 83 1.4 Removal of Prostheses 7 0.1
Malalignment 66 1.1 Reinsertion of Components 6 0.1
Instability 62 1.1 Patella Only 5 0.1
Wear Tibial 48 0.8 Femoral Component* 4 0.1
Other 283 4.8 Cement Only 2 0.0
TOTAL 5894 100.0 Tibial Component 1 0.0
TOTAL 5894 100.0
Note: *Bicompartmental Component
Figure KP10 Cumulative Incidence Revision Diagnosis of Primary Unicompartmental Knee Replacement (Primary Diagnosis
OA)
Unicompartmental
10.0%
Loosening
Progression Of Disease
Pain
8.0% Infection
Lysis
6.0%
4.0%
2.0%
0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Table KP19 Cumulative Percent Revision of Primary Unicompartmental Knee Replacement by Age (Primary Diagnosis OA)
N N
Revised Total
<55 1361 6964 3.2 (2.8, 3.7) 9.2 (8.5, 9.9) 12.8 (12.0, 13.7) 22.7 (21.5, 23.9) 33.1 (31.2, 35.2) 36.5 (33.1, 40.2)
55-64 2255 16499 2.3 (2.1, 2.6) 5.9 (5.5, 6.3) 8.6 (8.2, 9.1) 15.8 (15.1, 16.5) 25.6 (24.3, 27.0) 26.9 (25.2, 28.6)
65-74 1670 15759 1.9 (1.7, 2.2) 5.0 (4.6, 5.3) 7.0 (6.6, 7.5) 13.2 (12.5, 13.8) 18.7 (17.7, 19.9) 19.2 (17.8, 20.6)
≥75 608 9439 1.8 (1.6, 2.1) 3.9 (3.5, 4.4) 5.3 (4.9, 5.9) 8.4 (7.7, 9.1) 9.9 (8.9, 11.0)
TOTAL 5894 48661
Figure KP11 Cumulative Percent Revision of Primary Unicompartmental Knee Replacement by Age (Primary Diagnosis OA)
40% <55 vs ≥75

<55 0 - 6Mth: HR=1.39 (1.04, 1.87),p=0.028
55-64
6Mth - 1Yr: HR=2.02 (1.60, 2.55),p<0.001
35% 65-74
≥75 1Yr - 2Yr: HR=3.04 (2.48, 3.73),p<0.001
2Yr - 4.5Yr: HR=2.86 (2.41, 3.38),p<0.001
30%
4.5Yr - 6Yr: HR=3.07 (2.44, 3.87),p<0.001
6Yr - 8Yr: HR=3.04 (2.44, 3.77),p<0.001

25%
8Yr - 9Yr: HR=3.56 (2.59, 4.91),p<0.001
9Yr - 10Yr: HR=5.07 (3.69, 6.99),p<0.001
20%
10Yr+: HR=7.06 (5.23, 9.52),p<0.001
55-64 vs ≥75
15%
0 - 1Yr: HR=1.28 (1.07, 1.54),p=0.008
1Yr - 1.5Yr: HR=1.75 (1.39, 2.21),p<0.001
10% 1.5Yr - 4Yr: HR=1.83 (1.57, 2.13),p<0.001
4Yr - 7Yr: HR=2.13 (1.81, 2.50),p<0.001
5% 7Yr - 10Yr: HR=2.69 (2.19, 3.31),p<0.001
10Yr+: HR=5.37 (4.05, 7.13),p<0.001
0% 65-74 vs ≥75
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 - 6Mth: HR=1.15 (0.90, 1.48),p=0.272
Years Since Primary Procedure 6Mth - 1Yr: HR=1.01 (0.80, 1.27),p=0.933
1Yr - 2Yr: HR=1.46 (1.20, 1.79),p<0.001
2Yr - 5Yr: HR=1.52 (1.30, 1.78),p<0.001
5Yr - 7Yr: HR=1.67 (1.36, 2.04),p<0.001
7Yr - 9Yr: HR=2.10 (1.66, 2.66),p<0.001
9Yr+: HR=3.06 (2.37, 3.95),p<0.001

<55 6964 6326 5288 4495 2243 249 48
55-64 16499 15082 12869 11049 5558 531 99
65-74 15759 14334 12153 10364 5251 550 116
≥75 9439 8706 7363 6084 2587 141 28

a o a .o rg.a u 183
Table KP20 Cumulative Percent Revision of Primary Unicompartmental Knee Replacement by Gender and Age (Primary
Diagnosis OA)
N N
Revised Total
Male 2839 25794 2.1 (1.9, 2.3) 5.3 (5.0, 5.6) 7.5 (7.1, 7.8) 13.7 (13.2, 14.2) 21.5 (20.4, 22.6) 22.4 (21.1, 23.8)
<55 581 3098 3.2 (2.6, 3.9) 9.0 (8.0, 10.2) 12.3 (11.1, 13.6) 21.9 (20.2, 23.8) 34.2 (31.0, 37.6)
55-64 1161 8815 2.3 (2.0, 2.7) 5.8 (5.3, 6.4) 8.6 (8.0, 9.2) 15.6 (14.7, 16.6) 25.3 (23.5, 27.3) 27.1 (24.7, 29.7)
65-74 814 8823 1.7 (1.5, 2.1) 4.5 (4.1, 5.0) 6.1 (5.6, 6.7) 11.7 (10.9, 12.6) 17.2 (15.7, 18.8) 17.2 (15.7, 18.8)
≥75 283 5058 1.6 (1.3, 2.0) 3.6 (3.1, 4.2) 4.8 (4.2, 5.4) 7.8 (6.9, 8.8) 9.5 (8.0, 11.4)
Female 3055 22867 2.4 (2.2, 2.6) 6.1 (5.8, 6.4) 8.8 (8.4, 9.2) 15.6 (15.1, 16.2) 22.9 (21.9, 23.9) 24.4 (22.9, 26.0)
<55 780 3866 3.2 (2.7, 3.9) 9.3 (8.4, 10.3) 13.2 (12.2, 14.4) 23.2 (21.7, 24.9) 32.4 (30.0, 35.0)
55-64 1094 7684 2.3 (2.0, 2.7) 6.0 (5.4, 6.5) 8.7 (8.1, 9.4) 16.0 (15.1, 17.0) 25.9 (24.0, 27.9)
65-74 856 6936 2.2 (1.9, 2.6) 5.5 (5.0, 6.1) 8.1 (7.5, 8.8) 14.9 (13.9, 15.9) 20.6 (19.0, 22.3) 21.4 (19.2, 23.7)
≥75 325 4381 2.0 (1.7, 2.5) 4.3 (3.7, 5.0) 6.0 (5.3, 6.8) 9.1 (8.1, 10.1) 10.4 (9.2, 11.9)
TOTAL 5894 48661
Figure KP12 Cumulative Percent Revision of Primary Unicompartmental Knee Replacement by Gender (Primary Diagnosis OA)

40%
Male
Female vs Male
Female
30%
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Male 25794 23424 19615 16451 7787 743 148
Female 22867 21024 18058 15541 7852 728 143

Table KP21 Cumulative Percent Revision of Primary Unicompartmental Knee Replacement by Position (Primary Diagnosis OA)
N N
Position 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Lateral 265 1992 2.0 (1.5, 2.8) 5.3 (4.4, 6.4) 8.6 (7.4, 10.0) 15.3 (13.5, 17.3) 23.5 (20.2, 27.2)
Medial 5080 43298 2.2 (2.1, 2.4) 5.7 (5.4, 5.9) 8.0 (7.8, 8.3) 14.5 (14.1, 14.9) 22.2 (21.4, 23.1) 23.3 (22.2, 24.4)
TOTAL 5345 45290
Note: Excludes 3,371 primary unicompartmental knee procedures with unknown/missing position
Figure KP13 Cumulative Percent Revision of Primary Unicompartmental Knee Replacement by Position (Primary Diagnosis OA)

40%
Lateral
Lateral vs Medial
Medial
30%
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Lateral 1992 1855 1605 1383 710 59 14
Medial 43298 39332 33052 27872 13207 1098 212
Table KP22 Cumulative Percent Revision of Lateral Primary Unicompartmental Knee Replacement by Prosthesis Combination
Femoral Tibial N N
Endo-Model Endo-Model
16 141 0.0 (0.0, 0.0) 3.9 (1.6, 9.2) 7.5 (4.0, 13.9)
Sled Sled
Freedom Freedom
20 150 0.7 (0.1, 4.7) 5.8 (2.9, 11.2) 9.9 (5.9, 16.5)
PKR/Active PKR/Active
GRU GRU 23 193 2.6 (1.1, 6.2) 4.2 (2.1, 8.3) 5.3 (2.9, 9.7) 12.8 (8.5, 19.0)
Genesis Genesis 24 137 1.5 (0.4, 5.7) 5.8 (3.0, 11.3) 9.6 (5.7, 15.9) 17.0 (11.5, 24.8)
M/G M/G 8 54 1.9 (0.3, 12.4) 3.7 (0.9, 14.1) 3.7 (0.9, 14.1) 10.9 (4.6, 24.3)
Oxford (cless) Oxford (ctd) 2 51 2.1 (0.3, 13.9) 2.1 (0.3, 13.9) 2.1 (0.3, 13.9)
Oxford (ctd) Oxford (ctd) 30 158 6.4 (3.5, 11.6) 9.1 (5.5, 14.9) 13.1 (8.5, 19.8) 21.7 (15.2, 30.5)
Preservation
Preservation 16 149 0.0 (0.0, 0.0) 3.4 (1.4, 8.0) 6.8 (3.7, 12.3) 10.0 (6.0, 16.4)
Fixed
Repicci II Repicci II 62 258 2.3 (1.1, 5.1) 7.1 (4.5, 11.0) 12.8 (9.2, 17.6) 20.9 (16.2, 26.8)
Unix Unix 21 184 1.1 (0.3, 4.4) 3.4 (1.6, 7.5) 7.2 (4.1, 12.3) 11.7 (7.5, 18.1)
ZUK ZUK 8 176 0.0 (0.0, 0.0) 2.1 (0.7, 6.3) 5.8 (2.6, 13.0)
Other (28) 35 341 3.5 (1.9, 6.2) 6.8 (4.4, 10.3) 8.6 (5.8, 12.6) 13.9 (9.8, 19.6)
TOTAL 265 1992
Note: Only combinations with over 50 procedures have been listed.

a o a .o rg.a u 185
Primary Total Knee Replacement

CLASS OF TOTAL KNEE REPLACEMENT
The Registry defines a total knee replacement High use prosthesis systems are sub-divided. This
as a replacement of the entire femorotibial enables the identification of differences or
articulation using a single femoral and a single potential differences in outcome between
tibial prosthesis. This may or may not be prostheses with different characteristics within
combined with a patellar resurfacing each of these systems.
replacement.
Low use systems are unlikely to be sub-divided.
In this report, the Registry details the outcome This is because of small numbers or insufficient
of total knee replacement based on specific follow up. The exception is, if the entire system is
patient and prosthesis characteristics. In identified as having a higher than anticipated
addition, the outcome for different types of rate of revision. The Registry then undertakes a
total knee prostheses are presented. catalogue range specific analysis to determine
if the higher than anticipated rate of revision is
Most total knee systems have a variety of associated with specific prosthesis
individual prostheses within the system that vary characteristics within that system.
based on distinguishing prosthesis
characteristics. Where possible, the Registry To enable the Registry to undertake range
sub-divides these systems into the specific specific analyses uniformly across all knee
prosthesis types. The initial characteristic used is systems, it is necessary to link the different
fixation. Further sub-division is based on mobility, catalogue ranges to the specific prosthesis
stability and flexion capacity. However, this characteristics for every prosthesis within the
further system sub-division is not uniformly system. This is an ongoing process with
applied to all knee systems at this time. increasing numbers of systems being sub-
divided.

DEMOGRAPHICS
There have been 547,407 primary total knee There has been a decrease in the proportion of
replacement procedures reported to the patients aged 75 to 84 years from 29.5% in 2003,
Registry. This is an additional 52,836 procedures to 21.6% in 2016. The proportion of patients
compared to the last report. aged less than 55 years remains small (6.9% in
2016) and there has been little change in that
Primary total knee replacement continues to proportion since 2003 (Figure KT2).
increase. In 2016, there were 2.8% more
procedures than 2015 and 139.8% more than in
2003. As a proportion of all knee replacement Figure KT2 Primary Total Knee Replacement by Age
procedures, primary total knee replacement
increased from 76.7% in 2003 to 87.0% in 2016. 100%
<55 55-64
90% 65-74 75-84
≥85
Osteoarthritis is the most common diagnosis for
80%
primary total knee replacement (97.6%).
70%
60%
There have been 547,407 primary total knee
50%
replacement procedures reported to the
Registry. This is an additional 52,836 40%
procedures compared to the last report. 30%
20%
In 2016, primary total knee replacement 10%

remains more common in females (56.1%). This 0%
proportion has remained constant since 2003
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
(Figure KT1). The mean age of patients is 68.5
years (Table KT1).
Detailed demographic information on primary total knee replacement is
Shoulder Arthroplasty’ on the AOANJRR website:
Figure KT1 Primary Total Knee Replacement by Gender https://aoanjrr.sahmri.com/annual-reports-2017.
100%
Male
90% Female
80%
70%
60%
50%
40%
30%
20%
10%
0%
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
Table KT1 Age and Gender of Primary Total Knee Replacement

Female 310950 56.8% 8 103 69 68.8 9.4
Male 236457 43.2% 8 101 68 68.2 9.2
TOTAL 547407 100.0% 8 103 69 68.5 9.3

a o a .o rg.a u 187
Patellar resurfacing at the time of the primary Figure KT5 Primary Total Knee Replacement by Computer
Navigation
total knee replacement continues to increase
from a low of 41.5% in 2005 to 64.4% in 2016 100%
Computer Navigated
(Figure KT3). 90% Non Navigated
80%
70%
Figure KT3 Primary Total Knee Replacement by Patella
Usage 60%
50%
100%
Patella Used
No Patella 40%
90%
30%
80%
20%
70%
10%
60%
0%
50%
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
40%
30%
20%
10% The use of cross-linked polyethylene (XLPE) in

primary total knee replacement continues to
0%
increase. The proportion of procedures using
03
04
05
06
07
08
09
10
11
12
13
14
15
16
XLPE was 7.1% in 2003 compared to 57.0% in

20
20
20
20
20
20
20
20
20
20
20
20
20
20
2016 (Figure KT6).
The most common method of fixation is

cementing both femoral and tibial Figure KT6 Primary Total Knee Replacement by
Polyethylene Type
components. This has increased from 44.8% in
2003 to 66.4% in 2016. The use of cementless 100%
Non XLPE
fixation continues to decrease from a peak of 90% XLPE
26.3% in 2003 to 11.8% in 2016 (Figure KT4).
80%
70%
60%
Figure KT4 Primary Total Knee Replacement by Fixation
50%
100%
Cemented 40%
90% Cementless
Hybrid 30%
80%
20%
70%
10%
60%
0%
50%
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
40%
30%
20%
Cruciate retaining (CR) and posterior stabilised
10%
(PS) prostheses are reported separately for the
0% majority of total knee prostheses. This reporting
is based on the design of the femoral
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
component. In 2016, the most commonly used

femoral prostheses were the Triathlon CR
(18.2%), Nexgen CR Flex (12.3%) and Nexgen
The proportion of primary total knee LPS Flex (5.7%) (Table KT2). The most used
replacement procedures inserted with prostheses are also reported based on fixation
computer navigation has increased from 2.4% (cemented, cementless and hybrid) (Tables KT3
in 2003 to 30.8% in 2016 (Figure KT5). to KT5).

Table KT2 10 Most Used Femoral Prostheses in Primary Total Knee Replacement
2003 2013 2014 2015 2016

3184 LCS CR 7407 Triathlon CR 8091 Triathlon CR 8703 Triathlon CR 9467 Triathlon CR
2847 Duracon 6179 Nexgen CR Flex 6382 Nexgen CR Flex 6337 Nexgen CR Flex 6416 Nexgen CR Flex
2150 Nexgen CR 3259 LCS CR 3216 LCS CR 3327 Vanguard CR 2971 Nexgen LPS Flex
1419 PFC Sigma CR 2814 Nexgen LPS Flex 3004 Vanguard CR 3106 Nexgen LPS Flex 2836 Vanguard CR
1354 Scorpio CR 2698 PFC Sigma CR 2896 Nexgen LPS Flex 2925 LCS CR 2721 LCS CR
1058 Genesis II CR 2653 Vanguard CR 2286 PFC Sigma CR 2216 Attune CR 2476 Attune CR
Legion Oxinium
1002 Natural Knee II 1598 Genesis II CR 2018 2000 Legion Oxinium PS 1949 Legion Oxinium PS
PS
Genesis II Oxinium GMK Sphere
902 Nexgen LPS 1537 1510 Genesis II CR 1455 PFC Sigma CR 1534
PS Primary
Genesis II Oxinium Genesis II Oxinium
883 Profix 1388 Legion Oxinium PS 1404 1397 Genesis II CR 1475
PS PS
Genesis II Oxinium
751 Scorpio PS 1292 PFC Sigma PS 1254 Genesis II PS 1390 1451 Evolution
PS
10 Most Used
15550 (10) 71.5% 30825 (10) 69.3% 32061 (10) 67.8% 32856 (10) 64.8% 33296 (10) 63.9%
Remainder
6184 (47) 28.5% 13668 (74) 30.7% 15221 (71) 32.2% 17849 (75) 35.2% 18830 (69) 36.1%
TOTAL
21734 (57) 100.0% 44493 (84) 100.0% 47282 (81) 100.0% 50705 (85) 100.0% 52126 (79) 100.0%
Table KT3 10 Most Used Femoral Prostheses in Cemented Primary Total Knee Replacement
2003 2013 2014 2015 2016

1212 Duracon 3390 Triathlon CR 4033 Triathlon CR 4644 Triathlon CR 5367 Triathlon CR
933 LCS CR 2388 Nexgen LPS Flex 2540 Nexgen LPS Flex 2741 Nexgen LPS Flex 3163 Nexgen CR Flex
826 Nexgen LPS 2254 Nexgen CR Flex 2345 Nexgen CR Flex 2718 Nexgen CR Flex 2652 Nexgen LPS Flex
Genesis II Oxinium
760 Nexgen CR 1537 2018 Legion Oxinium PS 2216 Attune CR 2476 Attune CR
PS
Genesis II Oxinium
693 Nexgen LPS Flex 1386 Legion Oxinium PS 1404 2000 Legion Oxinium PS 1949 Legion Oxinium PS
PS
Genesis II Oxinium GMK Sphere
644 Genesis II CR 1206 Genesis II PS 1276 Vanguard CR 1390 1533
PS Primary
Genesis II Oxinium
494 Profix 1167 Vanguard CR 1225 Genesis II PS 1327 Vanguard CR 1475
PS
Genesis II Oxinium
471 1089 PFC Sigma PS 1017 PFC Sigma CR 1189 Genesis II PS 1451 Evolution
CR
GMK Sphere
471 PFC Sigma PS 1088 PFC Sigma CR 941 Genesis II CR 1133 1134 Vanguard CR
Primary
418 Genesis II PS 996 Genesis II CR 927 PFC Sigma PS 1088 Evolution 1047 Attune PS
10 Most Used
6922 (10) 71.8% 16501 (10) 66.6% 17726 (10) 64.2% 20446 (10) 64.1% 22247 (10) 64.5%
Remainder
2718 (38) 28.2% 8267 (68) 33.4% 9891 (67) 35.8% 11434 (72) 35.9% 12261 (65) 35.5%
TOTAL
9640 (48) 100.0% 24768 (78) 100.0% 27617 (77) 100.0% 31880 (82) 100.0% 34508 (75) 100.0%

a o a .o rg.a u 189
Table KT4 10 Most Used Femoral Prostheses in Cementless Primary Total Knee Replacement
2003 2013 2014 2015 2016

1490 LCS CR 1739 Triathlon CR 1687 Nexgen CR Flex 1590 Nexgen CR Flex 1373 Nexgen CR Flex
810 Nexgen CR 1732 Nexgen CR Flex 1626 Triathlon CR 1373 Triathlon CR 1238 LCS CR
519 Natural Knee II 1472 LCS CR 1427 LCS CR 1273 LCS CR 1228 Triathlon CR
488 Active Knee 440 RBK 410 Vanguard CR 410 Vanguard CR 394 Scorpio NRG CR
484 Duracon 413 Vanguard CR 385 RBK 360 Scorpio NRG CR 287 Vanguard CR
318 Scorpio CR 354 PFC Sigma CR 252 Score 347 RBK 264 RBK
313 PFC Sigma CR 249 ACS 247 Scorpio NRG CR 249 Score 226 Nexgen LPS Flex
304 RBK 248 Nexgen LPS Flex 237 PFC Sigma CR 245 Nexgen LPS Flex 152 Score
188 Profix 238 Score 210 Nexgen LPS Flex 184 PFC Sigma CR 138 GMK Primary
182 Scorpio PS 233 Active Knee 176 GMK Primary 143 Natural Knee Flex 131 PFC Sigma CR
10 Most Used
5096 (10) 87.8% 7118 (10) 84.4% 6657 (10) 84.7% 6174 (10) 85.8% 5431 (10) 87.5%
Remainder
705 (17) 12.2% 1318 (26) 15.6% 1198 (24) 15.3% 1019 (22) 14.2% 776 (17) 12.5%
TOTAL
5801 (27) 100.0% 8436 (36) 100.0% 7855 (34) 100.0% 7193 (32) 100.0% 6207 (27) 100.0%
Table KT5 10 Most Used Femoral Prostheses in Hybrid Primary Total Knee Replacement
2003 2013 2014 2015 2016

1151 Duracon 2278 Triathlon CR 2432 Triathlon CR 2686 Triathlon CR 2872 Triathlon CR
765 PFC Sigma CR 2193 Nexgen CR Flex 2350 Nexgen CR Flex 2029 Nexgen CR Flex 1880 Nexgen CR Flex
761 LCS CR 1256 PFC Sigma CR 1318 Vanguard CR 1590 Vanguard CR 1415 Vanguard CR
742 Scorpio CR 1073 Vanguard CR 1032 PFC Sigma CR 777 LCS CR 698 LCS CR
580 Nexgen CR 893 LCS CR 881 LCS CR 520 Genesis II CR 513 Genesis II CR
360 Genesis II CR 547 Genesis II CR 509 Genesis II CR 391 Scorpio CR 447 Apex Knee CR
276 Maxim 352 Scorpio CR 382 Scorpio CR 377 Legion CR 376 BalanSys
232 Natural Knee II 321 Triathlon PS 294 Triathlon PS 367 PFC Sigma CR 375 PFC Sigma CR
205 AGC 203 PFC Sigma PS 288 Legion CR 337 Score 363 Scorpio CR
204 Scorpio PS 194 Active Knee 283 ACS 294 Natural Knee Flex 312 Score
10 Most Used
5276 (10) 83.8% 9310 (10) 82.5% 9769 (10) 82.7% 9368 (10) 80.5% 9251 (10) 81.1%
Remainder
1017 (26) 16.2% 1979 (34) 17.5% 2041 (33) 17.3% 2264 (34) 19.5% 2160 (31) 18.9%
TOTAL
6293 (36) 100.0% 11289 (44) 100.0% 11810 (43) 100.0% 11632 (44) 100.0% 11411 (41) 100.0%


Primary Diagnosis
The most common diagnosis for primary total There is no difference in the rate of revision
knee replacement is osteoarthritis (97.6%), between ‘other inflammatory arthritis’ and
followed by rheumatoid arthritis (1.4%), ‘other osteoarthritis (Table KT6 and Figure KT7).
inflammatory arthritis’ (0.5%) and osteonecrosis
(0.3%).
Rheumatoid arthritis has a lower rate of revision Rheumatoid arthritis has a lower rate of
compared to osteoarthritis after nine months. revision compared to osteoarthritis.
Osteonecrosis has a higher rate of revision
compared to osteoarthritis.
Table KT6 Cumulative Percent Revision of Primary Total Knee Replacement by Primary Diagnosis
N N
Revised Total
Osteoarthritis 19627 534202 1.0 (1.0, 1.1) 2.7 (2.7, 2.8) 3.6 (3.6, 3.7) 5.3 (5.2, 5.4) 7.4 (7.2, 7.6) 8.0 (7.7, 8.3)
Rheumatoid Arthritis 272 7542 1.0 (0.8, 1.2) 2.2 (1.9, 2.6) 2.9 (2.5, 3.3) 4.8 (4.2, 5.5) 6.7 (5.7, 7.9) 6.7 (5.7, 7.9)
Other Inflammatory Arthritis 119 2705 1.5 (1.1, 2.0) 3.2 (2.5, 4.0) 4.2 (3.4, 5.1) 6.4 (5.2, 7.8) 9.4 (7.0, 12.6)
Osteonecrosis 92 1777 1.2 (0.8, 1.8) 3.9 (3.0, 5.0) 5.4 (4.3, 6.7) 7.4 (5.9, 9.2)
Other (5) 116 1181 2.6 (1.8, 3.8) 8.2 (6.5, 10.2) 11.0 (8.9, 13.4) 17.5 (14.2, 21.4)
TOTAL 20226 547407
Note: Only primary diagnoses with over 1,000 procedures have been listed
Figure KT7 Cumulative Percent Revision of Primary Total Knee Replacement by Primary Diagnosis

24%
Osteoarthritis
Rheumatoid Arthritis vs Osteoarthritis
22% Rheumatoid Arthritis
Other Inflammatory Arthritis 0 - 9Mth: HR=0.92 (0.71, 1.18),p=0.496
20% Osteonecrosis 9Mth - 1.5Yr: HR=0.49 (0.36, 0.69),p<0.001
1.5Yr+: HR=0.70 (0.60, 0.81),p<0.001
18%
16% Other Inflammatory Arthritis vs Osteoarthritis

14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Osteoarthritis 534202 474281 363321 268621 93358 7947 1861
Other Inflammatory Arthritis 2705 2375 1804 1314 470 71 20
Osteonecrosis 1777 1581 1181 869 326 26 3

a o a .o rg.a u 191
PROSTHESIS TYPES
There have been 516 femoral and tibial lowest at 5.1% (Table KT7).
prosthesis combinations used in primary total There are 39 cementless femoral and tibial
knee replacement reported to the Registry. In prosthesis combinations with more than 400
2016, 119 femoral and tibial combinations were procedures. Of those with a 16 year cumulative
used. This is eight less than in 2015. percent revision, the Nexgen CR/Nexgen is the
lowest at 4.4% (Table KT8).
The cumulative percent revision of the 144
combinations with more than 400 procedures
per combination are listed in Tables KT7 to KT9.
Although the listed combinations are a small 516 different femoral and tibial prosthesis
proportion of all possible combinations, they combinations have been reported to the
represent 96.4% of all primary total knee Registry. Outcomes at 16 years are being
replacement. The ‘Other’ group is the reported for the first time.
combined outcome of the remaining 372
prosthesis combinations with less than 400
procedures reported per combination. There are 42 combinations of primary total knee
replacement using hybrid fixation and with
There are 63 cemented femoral and tibial more than 400 procedures. The PFC Sigma
prosthesis combinations with more than 400 CR/PFC Sigma has the lowest 16 year
procedures. Of those with a 16 year cumulative cumulative percent revision (4.8%) (Table KT9).
percent revision, the Nexgen CR/Nexgen is the
Table KT7 Cumulative Percent Revision of Cemented Primary Total Knee Replacement by Prosthesis Combination
Femoral Tibial N N
ACS ACS Mobile 12 533 1.0 (0.4, 2.4) 1.9 (0.9, 3.9)
AGC AGC 195 3497 0.5 (0.3, 0.9) 2.5 (2.0, 3.0) 3.6 (3.0, 4.3) 5.6 (4.8, 6.5) 8.8 (7.4, 10.4) 9.6 (7.6, 12.1)
Active Knee Active Knee 48 1698 0.9 (0.5, 1.5) 2.4 (1.7, 3.4) 3.7 (2.7, 5.0) 4.8 (3.4, 6.6)
Advance Advance II 56 918 1.5 (0.9, 2.6) 4.2 (3.1, 5.7) 4.8 (3.6, 6.4) 7.1 (5.4, 9.4)
Apex Knee CR Apex Knee 3 1016 0.1 (0.0, 0.7) 0.7 (0.2, 2.2)
Apex Knee PS Apex Knee 25 1953 0.7 (0.4, 1.2) 3.4 (1.9, 5.9)
Attune CR Attune 49 5691 0.6 (0.4, 0.9) 2.1 (1.4, 3.1)
Attune PS Attune 18 2693 0.4 (0.2, 0.8) 1.1 (0.6, 1.9)
BalanSys BalanSys 27 1636 0.3 (0.1, 0.7) 1.6 (1.0, 2.5) 2.1 (1.3, 3.2) 4.2 (2.5, 7.0)
Columbus Columbus 8 403 0.8 (0.3, 2.5) 2.5 (1.2, 5.4) 2.5 (1.2, 5.4)
Duracon Duracon* 453 8968 1.0 (0.8, 1.2) 2.4 (2.1, 2.8) 3.3 (2.9, 3.7) 4.9 (4.4, 5.4) 7.0 (6.3, 7.9) 7.2 (6.4, 8.2)
E.Motion E.Motion 23 519 2.0 (1.1, 3.7) 4.9 (3.2, 7.4) 5.4 (3.6, 8.1)
Evolis Evolis 14 797 0.3 (0.1, 1.1) 1.0 (0.5, 2.1) 1.6 (0.9, 3.0)
Evolution Evolution 32 3107 0.7 (0.4, 1.2) 2.3 (1.5, 3.5)
GMK Primary GMK Primary 17 587 1.1 (0.5, 2.3) 2.8 (1.7, 4.7) 5.1 (2.6, 9.8)
GMK Sphere
GMK Primary 49 3417 1.2 (0.8, 1.7) 2.7 (2.0, 3.7)
Primary
Genesis II CR Genesis II 466 13669 0.9 (0.8, 1.1) 2.4 (2.1, 2.7) 3.1 (2.8, 3.4) 4.3 (3.9, 4.7) 5.6 (4.9, 6.5) 6.0 (5.0, 7.1)
Genesis II CR Profix Mobile* 35 490 1.7 (0.8, 3.3) 3.4 (2.1, 5.4) 5.4 (3.7, 8.0) 9.0 (6.3, 12.9)
Genesis II
Genesis II 347 7488 1.0 (0.8, 1.3) 2.8 (2.4, 3.2) 3.7 (3.2, 4.2) 6.1 (5.5, 6.9) 10.9 (8.3, 14.2)
Oxinium CR
Genesis II
Genesis II 785 15823 1.5 (1.3, 1.7) 3.8 (3.5, 4.1) 5.2 (4.8, 5.6) 7.5 (6.9, 8.1)
Oxinium PS
Genesis II PS Genesis II 571 15816 1.2 (1.1, 1.4) 2.8 (2.6, 3.1) 3.7 (3.4, 4.0) 5.0 (4.5, 5.5) 6.2 (5.2, 7.3)
Journey
Journey* 245 3032 1.4 (1.0, 1.9) 4.6 (3.9, 5.4) 6.4 (5.6, 7.4) 10.9 (9.4, 12.7)
Oxinium
Kinemax Plus Kinemax Plus* 111 1826 0.9 (0.6, 1.5) 2.4 (1.8, 3.3) 3.1 (2.4, 4.0) 4.6 (3.7, 5.7) 8.5 (6.9, 10.4) 9.3 (7.2, 12.0)
LCS CR LCS 299 3939 1.0 (0.7, 1.4) 3.8 (3.2, 4.4) 5.0 (4.4, 5.8) 7.2 (6.4, 8.1) 9.1 (8.1, 10.2) 9.4 (8.2, 10.8)

Femoral Tibial N N
LCS CR MBT 364 10638 0.8 (0.7, 1.0) 2.5 (2.2, 2.8) 3.4 (3.0, 3.8) 5.2 (4.7, 5.9)
LCS PS MBT* 36 492 1.4 (0.7, 3.0) 5.6 (3.9, 8.1) 7.3 (5.2, 10.2)
Legion CR Genesis II 29 1266 1.5 (0.9, 2.4) 2.4 (1.6, 3.6) 3.3 (2.2, 4.9)
Legion
Genesis II 59 2696 0.8 (0.5, 1.3) 2.4 (1.8, 3.2) 3.1 (2.3, 4.0)
Oxinium CR
Legion
Genesis II 261 9937 1.1 (0.9, 1.3) 3.3 (2.9, 3.7) 4.3 (3.7, 4.9)
Oxinium PS
Legion PS Genesis II 73 3939 1.0 (0.7, 1.3) 2.1 (1.7, 2.7) 2.6 (2.0, 3.3)
MRK MRK 7 430 0.7 (0.2, 2.2) 1.8 (0.9, 3.7) 1.8 (0.9, 3.7)
Maxim Maxim* 37 498 1.2 (0.5, 2.7) 2.6 (1.5, 4.5) 4.8 (3.2, 7.1) 6.5 (4.6, 9.2)
Natural Natural
33 1449 1.1 (0.7, 1.9) 2.8 (1.9, 4.0) 3.2 (2.2, 4.5)
Knee Flex Knee II
Natural Natural
49 1754 0.5 (0.2, 0.9) 1.3 (0.8, 2.0) 1.9 (1.3, 2.7) 3.4 (2.5, 4.5) 4.1 (3.0, 5.7)
Knee II Knee II*
Nexgen CR Nexgen 119 3853 0.6 (0.4, 0.8) 1.4 (1.1, 1.9) 1.9 (1.5, 2.4) 2.9 (2.4, 3.6) 5.1 (4.0, 6.4) 5.1 (4.0, 6.4)
Nexgen CR Natural
8 804 0.2 (0.1, 1.0) 0.7 (0.3, 1.8) 0.7 (0.3, 1.8)
Flex Knee II
Nexgen CR
Nexgen 315 19517 0.7 (0.6, 0.8) 1.5 (1.3, 1.7) 2.1 (1.8, 2.3) 2.8 (2.4, 3.2)
Flex
Nexgen LCCK Nexgen 29 706 2.0 (1.1, 3.4) 3.6 (2.4, 5.5) 5.2 (3.5, 7.7) 5.2 (3.5, 7.7)
Nexgen LPS Nexgen 239 5776 1.0 (0.8, 1.3) 2.3 (2.0, 2.8) 3.0 (2.5, 3.5) 4.8 (4.2, 5.5) 6.0 (5.2, 7.0) 6.0 (5.2, 7.0)
Nexgen LPS
Nexgen 956 29701 0.9 (0.8, 1.0) 2.3 (2.1, 2.5) 3.1 (2.9, 3.4) 5.0 (4.7, 5.4)
Flex
Optetrak-PS Optetrak 178 2603 1.5 (1.1, 2.0) 4.6 (3.8, 5.5) 6.3 (5.4, 7.4) 9.8 (8.3, 11.4)
Optetrak-PS Optetrak-RBK 43 768 1.5 (0.8, 2.6) 3.9 (2.7, 5.7) 5.1 (3.6, 7.2) 10.0 (6.8, 14.5)
PFC Sigma CR MBT 28 1153 0.9 (0.5, 1.6) 1.7 (1.1, 2.6) 2.1 (1.4, 3.2) 3.0 (2.0, 4.3)
PFC Sigma CR PFC Sigma 318 12226 0.8 (0.7, 1.0) 2.0 (1.7, 2.2) 2.4 (2.1, 2.7) 3.4 (3.0, 3.9) 5.7 (4.6, 7.1)
PFC Sigma PS MBT 231 5971 0.9 (0.7, 1.2) 2.7 (2.3, 3.1) 3.5 (3.0, 4.0) 4.8 (4.2, 5.5)
PFC Sigma PS PFC Sigma 274 7600 1.2 (0.9, 1.4) 2.5 (2.2, 2.9) 3.2 (2.8, 3.6) 4.7 (4.1, 5.4) 7.2 (5.9, 8.8)
Persona Persona 6 821 0.5 (0.2, 1.5) 1.5 (0.6, 3.5)
Profix Profix* 142 3285 1.1 (0.8, 1.5) 2.6 (2.1, 3.2) 3.2 (2.6, 3.9) 4.7 (4.0, 5.5) 4.9 (4.2, 5.9)
Profix Oxinium Profix* 81 999 1.9 (1.2, 3.0) 5.0 (3.8, 6.5) 6.6 (5.2, 8.4) 8.0 (6.5, 10.0)
RBK RBK 91 2290 1.0 (0.7, 1.5) 2.8 (2.1, 3.6) 3.6 (2.9, 4.5) 5.9 (4.7, 7.5)
SAIPH SAIPH 11 1333 0.5 (0.2, 1.2) 1.6 (0.8, 3.1)
Score Score 12 628 0.9 (0.4, 2.1) 1.5 (0.8, 3.1) 1.9 (1.0, 3.6)
Scorpio CR Series 7000 88 1793 0.8 (0.5, 1.4) 2.2 (1.6, 3.0) 2.9 (2.2, 3.8) 4.9 (3.9, 6.1) 6.4 (5.1, 7.9)
Scorpio NRG
Series 7000 37 1579 0.7 (0.4, 1.3) 1.7 (1.2, 2.6) 2.4 (1.7, 3.5)
CR
Scorpio NRG
Series 7000 61 2592 0.6 (0.4, 1.0) 1.6 (1.2, 2.2) 2.4 (1.8, 3.1)
PS
Scorpio PS Scorpio 31 511 1.2 (0.5, 2.6) 3.8 (2.4, 5.9) 4.4 (2.9, 6.6) 6.4 (4.5, 9.0)
Scorpio PS Scorpio+* 60 900 1.2 (0.7, 2.2) 4.0 (2.9, 5.5) 5.6 (4.3, 7.4) 7.0 (5.4, 9.0)
Scorpio PS Series 7000 184 3225 1.1 (0.8, 1.5) 2.9 (2.4, 3.5) 4.0 (3.4, 4.8) 6.8 (5.8, 7.9) 10.9 (8.3, 14.3)
Triathlon CR Triathlon 607 31060 0.8 (0.7, 0.9) 2.0 (1.8, 2.2) 2.5 (2.3, 2.7) 3.9 (3.4, 4.5)
Triathlon PS Triathlon 219 6676 1.4 (1.2, 1.7) 3.1 (2.6, 3.6) 4.0 (3.4, 4.5) 5.1 (4.3, 6.0)
Vanguard CR Maxim 178 7915 0.6 (0.5, 0.8) 2.2 (1.9, 2.7) 2.9 (2.5, 3.4) 4.3 (3.5, 5.3)
Vanguard CR Vanguard 16 983 0.5 (0.2, 1.2) 1.2 (0.7, 2.2) 1.4 (0.8, 2.6)
Vanguard PS Maxim 193 3751 1.9 (1.5, 2.4) 4.5 (3.8, 5.3) 5.7 (4.9, 6.6) 7.5 (6.1, 9.3)
Other (181) 540 8182 1.7 (1.4, 2.0) 4.4 (3.9, 4.9) 6.2 (5.7, 6.9) 9.1 (8.3, 9.9) 11.6 (10.4, 13.0) 12.5 (10.8, 14.4)
TOTAL 10131 301816
Note: Some cementless components have been cemented
Only combinations with over 400 procedures have been listed
* denotes prosthesis combinations that have not had any reported use in primary total knee procedures in 2016

a o a .o rg.a u 193
Table KT8 Cumulative Percent Revision of Cementless Primary Total Knee Replacement by Prosthesis Combination
Femoral Tibial N N
ACS ACS Fixed 26 575 1.7 (0.9, 3.3) 6.0 (4.1, 8.7)
Advance Advance 28 672 1.8 (1.0, 3.2) 4.6 (3.1, 6.7) 4.8 (3.3, 7.1)
Advantim Advantim* 59 1255 0.7 (0.4, 1.4) 2.7 (2.0, 3.8) 3.6 (2.7, 4.8) 5.2 (3.9, 6.9) 7.6 (5.4, 10.7)
Columbus Columbus 58 500 3.2 (2.0, 5.2) 7.7 (5.6, 10.4) 9.9 (7.5, 12.9) 13.5 (10.4, 17.3)
Duracon Duracon* 206 3539 1.1 (0.8, 1.4) 2.7 (2.2, 3.3) 3.7 (3.1, 4.4) 5.5 (4.8, 6.3) 8.3 (6.9, 9.9) 9.2 (7.1, 11.8)
GMK GMK
19 747 1.4 (0.7, 2.6) 3.2 (2.1, 5.0)
Primary Primary
Genesis II CR Genesis II 25 561 1.3 (0.6, 2.8) 4.4 (2.8, 6.7) 5.0 (3.3, 7.6)
Genesis II CR Profix Mobile* 35 505 1.4 (0.7, 2.9) 2.0 (1.1, 3.7) 3.0 (1.8, 4.9) 4.6 (3.1, 6.9) 8.1 (5.8, 11.3) 10.2 (6.9, 14.9)
Genesis II PS Genesis II 19 420 1.7 (0.8, 3.5) 3.5 (2.1, 5.8) 4.1 (2.5, 6.6)
LCS CR LCS 149 2348 1.4 (1.0, 2.0) 3.3 (2.7, 4.2) 4.3 (3.5, 5.2) 5.9 (5.0, 7.0) 6.9 (5.9, 8.1) 7.9 (6.5, 9.6)
LCS CR MBT 300 7580 1.1 (0.9, 1.4) 3.4 (3.0, 3.9) 4.3 (3.8, 4.8) 5.5 (4.8, 6.2)
LCS CR MBT Duofix 587 12806 1.3 (1.1, 1.5) 3.3 (3.0, 3.6) 4.1 (3.8, 4.5) 5.4 (5.0, 5.9) 7.2 (6.4, 8.2)
LCS Duofix MBT Duofix* 449 3649 1.6 (1.2, 2.1) 6.2 (5.5, 7.0) 10.1 (9.2, 11.2) 13.0 (11.9, 14.2)
Maxim Maxim* 39 612 1.6 (0.9, 3.0) 3.0 (1.9, 4.7) 3.3 (2.2, 5.1) 4.8 (3.3, 6.9) 8.4 (5.8, 12.2)
Natural Knee Natural
29 1193 0.9 (0.5, 1.6) 2.2 (1.4, 3.3) 2.6 (1.7, 3.8)
Flex Knee II
Natural Natural
227 2890 1.0 (0.7, 1.4) 2.2 (1.7, 2.8) 3.4 (2.8, 4.2) 7.1 (6.1, 8.2) 13.4 (11.5, 15.7)
Knee II Knee II*
Nexgen CR Nexgen 109 3402 0.6 (0.4, 0.9) 1.7 (1.3, 2.2) 2.2 (1.7, 2.7) 3.1 (2.5, 3.8) 4.4 (3.5, 5.4) 4.4 (3.5, 5.4)
Nexgen CR Nexgen TM CR 40 676 1.4 (0.7, 2.6) 4.4 (3.1, 6.4) 6.1 (4.5, 8.3) 6.7 (4.9, 9.1)
Nexgen CR
Nexgen 194 6886 1.1 (0.9, 1.4) 2.5 (2.1, 2.9) 3.1 (2.6, 3.6) 4.2 (3.5, 4.9)
Flex
Nexgen CR
Nexgen TM CR 201 8870 0.6 (0.4, 0.8) 1.9 (1.6, 2.2) 2.4 (2.1, 2.8) 3.6 (3.0, 4.3)
Flex
Nexgen TM
Nexgen LPS 24 1099 0.9 (0.4, 1.6) 1.4 (0.8, 2.4) 2.5 (1.6, 3.7) 3.1 (2.0, 4.8)
LPS
Nexgen LPS
Nexgen 20 670 2.7 (1.6, 4.3) 3.7 (2.4, 5.7)
Flex
Nexgen LPS Nexgen TM
28 931 1.2 (0.7, 2.2) 2.6 (1.7, 4.0) 3.7 (2.6, 5.4)
Flex LPS
PFC Sigma CR AMK Duofix* 54 1911 0.7 (0.4, 1.2) 1.5 (1.1, 2.2) 2.3 (1.7, 3.1) 3.0 (2.3, 4.1)
PFC Sigma CR MBT 62 994 2.3 (1.5, 3.5) 4.9 (3.7, 6.4) 5.7 (4.4, 7.4) 7.3 (5.6, 9.6)
PFC Sigma CR MBT Duofix 113 2548 1.2 (0.8, 1.7) 3.3 (2.7, 4.1) 4.2 (3.4, 5.1) 5.6 (4.6, 7.0)
Profix Profix* 88 1488 1.1 (0.7, 1.8) 3.5 (2.6, 4.5) 4.6 (3.6, 5.8) 6.2 (5.1, 7.7) 6.8 (5.4, 8.4)
RBK RBK 280 6293 1.4 (1.1, 1.7) 3.2 (2.8, 3.7) 4.2 (3.7, 4.8) 5.6 (4.9, 6.3)
Score Score 111 1877 1.5 (1.0, 2.2) 5.4 (4.3, 6.6) 7.3 (6.0, 8.9)
Scorpio CR Series 7000 200 3135 1.3 (1.0, 1.8) 3.4 (2.8, 4.1) 4.7 (4.0, 5.5) 7.4 (6.4, 8.5) 8.8 (7.5, 10.4)
Scorpio
Series 7000 60 2362 1.0 (0.6, 1.5) 2.3 (1.7, 3.2) 2.9 (2.2, 3.8)
NRG CR
Scorpio
Series 7000 66 1046 1.4 (0.8, 2.3) 5.7 (4.4, 7.4) 7.2 (5.7, 9.1)
NRG PS
Scorpio PS Series 7000 44 570 2.5 (1.5, 4.1) 5.3 (3.7, 7.5) 6.2 (4.5, 8.6) 7.7 (5.7, 10.2)
Triathlon PS Triathlon 46 1008 2.1 (1.4, 3.2) 3.8 (2.7, 5.1) 4.8 (3.6, 6.3)
Vanguard CR Regenerex 54 1386 1.1 (0.7, 1.9) 3.8 (2.8, 5.1) 5.2 (3.9, 6.9)
Other (72) 541 5243 2.8 (2.4, 3.3) 7.6 (6.9, 8.3) 9.2 (8.4, 10.1) 11.9 (10.9, 12.9) 14.3 (12.8, 15.9)
TOTAL 5400 112267

Table KT9 Cumulative Percent Revision of Hybrid Primary Total Knee Replacement by Prosthesis Combination
Femoral Tibial N N
ACS ACS Fixed 36 777 1.7 (1.0, 2.9) 7.4 (5.2, 10.5)
AGC AGC 58 1644 0.6 (0.3, 1.1) 1.4 (0.9, 2.1) 2.0 (1.4, 2.9) 3.4 (2.6, 4.6) 5.2 (3.8, 7.0)
Advance Advance II 21 453 1.1 (0.5, 2.7) 2.6 (1.4, 4.6) 3.5 (2.1, 5.8) 5.8 (3.7, 9.0)
Apex Knee CR Apex Knee 9 916 1.0 (0.5, 2.2) 1.8 (0.9, 3.9)
BalanSys BalanSys 6 702 0.8 (0.3, 2.0) 0.8 (0.3, 2.0)
Duracon Duracon* 421 7963 1.2 (1.0, 1.5) 2.7 (2.4, 3.1) 3.5 (3.1, 3.9) 4.9 (4.5, 5.5) 6.8 (6.1, 7.6) 7.3 (6.4, 8.4)
GMK Primary GMK Primary 11 439 0.5 (0.1, 2.0) 3.5 (1.9, 6.4)
Genesis II CR Genesis II 289 7265 0.9 (0.7, 1.1) 2.9 (2.5, 3.3) 3.9 (3.5, 4.5) 5.2 (4.6, 5.8) 6.0 (5.2, 6.9) 6.0 (5.2, 6.9)
Genesis II PS Genesis II 57 705 1.7 (1.0, 3.0) 4.5 (3.2, 6.3) 5.4 (4.0, 7.4) 8.7 (6.7, 11.2)
LCS CR LCS 133 2363 1.0 (0.7, 1.5) 2.7 (2.1, 3.5) 3.8 (3.1, 4.6) 5.3 (4.4, 6.3) 6.8 (5.7, 8.2) 7.2 (5.9, 8.8)
LCS CR MBT 242 8432 0.7 (0.6, 1.0) 2.2 (1.9, 2.6) 3.0 (2.6, 3.4) 4.2 (3.6, 4.8)
LCS CR MBT Duofix 29 889 1.5 (0.9, 2.6) 3.7 (2.5, 5.3) 3.9 (2.7, 5.6)
LCS Duofix MBT* 67 822 1.5 (0.8, 2.6) 5.5 (4.1, 7.3) 7.1 (5.5, 9.1) 9.3 (7.0, 12.2)
Legion CR Genesis II 46 1474 1.4 (0.9, 2.2) 4.2 (3.1, 5.7) 5.3 (3.8, 7.3)
Maxim Maxim* 99 1407 0.8 (0.4, 1.4) 2.7 (1.9, 3.7) 3.9 (3.0, 5.1) 6.3 (5.1, 7.9)
Natural Natural
20 1687 0.4 (0.2, 0.8) 1.0 (0.6, 1.8) 1.7 (1.0, 2.8)
Knee Flex Knee II
Natural Natural
92 1966 1.2 (0.8, 1.8) 2.2 (1.6, 2.9) 2.5 (1.9, 3.3) 4.1 (3.2, 5.2) 9.8 (7.2, 13.2)
Knee II Knee II*
Nexgen CR Nexgen 114 4111 0.4 (0.3, 0.7) 1.5 (1.2, 2.0) 2.1 (1.7, 2.6) 3.1 (2.5, 3.8) 3.9 (3.2, 4.8)
Nexgen CR
Nexgen 303 16425 0.8 (0.6, 0.9) 1.8 (1.6, 2.0) 2.2 (1.9, 2.5) 2.8 (2.4, 3.2)
Flex
Nexgen CR Nexgen TM
14 779 0.5 (0.2, 1.4) 1.3 (0.7, 2.5) 1.5 (0.8, 2.6) 1.9 (1.1, 3.2)
Flex CR
Nexgen LPS Nexgen 50 990 0.4 (0.2, 1.1) 2.6 (1.7, 3.8) 4.1 (3.0, 5.6) 5.6 (4.2, 7.5)
Nexgen LPS Flex Nexgen 35 803 2.1 (1.3, 3.4) 5.0 (3.5, 7.0) 5.3 (3.8, 7.3)
Nexgen TM
Nexgen LPS Flex 13 503 0.6 (0.2, 1.8) 1.8 (0.9, 3.5) 2.0 (1.1, 3.7) 2.7 (1.6, 4.7)
LPS
Optetrak-CR Optetrak 34 666 1.7 (0.9, 3.1) 3.6 (2.3, 5.7) 4.5 (3.0, 6.9) 8.7 (6.1, 12.4)
PFC Sigma CR MBT 170 3671 1.3 (0.9, 1.7) 3.2 (2.7, 3.9) 4.3 (3.6, 5.0) 5.4 (4.6, 6.3) 6.2 (5.1, 7.4)
PFC Sigma CR PFC Sigma 295 10858 0.6 (0.5, 0.8) 1.9 (1.6, 2.2) 2.4 (2.1, 2.8) 3.6 (3.1, 4.1) 4.8 (4.0, 5.6) 4.8 (4.0, 5.6)
PFC Sigma PS MBT Duofix 131 1921 1.8 (1.3, 2.5) 5.0 (4.0, 6.1) 6.9 (5.7, 8.2) 8.5 (7.2, 10.1)
Profix
Profix 56 592 1.9 (1.0, 3.4) 5.7 (4.1, 7.9) 7.4 (5.6, 9.9) 9.3 (7.1, 12.0)
Mobile*
Profix Profix* 35 769 0.8 (0.4, 1.7) 2.5 (1.6, 3.9) 3.9 (2.7, 5.6) 4.9 (3.5, 6.8)
RBK RBK 45 1370 1.0 (0.6, 1.7) 2.7 (1.9, 3.8) 3.6 (2.6, 4.9) 4.9 (3.5, 6.8)
Score Score 24 943 1.9 (1.1, 3.1) 4.0 (2.5, 6.2)
Scorpio CR Scorpio+* 135 1893 1.0 (0.6, 1.6) 2.8 (2.2, 3.7) 4.4 (3.5, 5.4) 7.3 (6.1, 8.6)
Scorpio CR Series 7000 227 6580 0.7 (0.5, 1.0) 2.0 (1.7, 2.4) 2.8 (2.4, 3.3) 4.2 (3.7, 4.9) 5.9 (5.0, 6.9) 5.9 (5.0, 6.9)
Scorpio NRG CR Series 7000 23 787 0.4 (0.1, 1.2) 1.9 (1.2, 3.3) 2.8 (1.7, 4.4)
Scorpio PS Scorpio+* 43 905 1.0 (0.5, 1.9) 2.6 (1.7, 3.9) 3.4 (2.4, 4.8) 4.4 (3.2, 6.1) 6.8 (4.7, 9.6)
Scorpio PS Series 7000 86 1072 1.1 (0.6, 2.0) 4.3 (3.2, 5.7) 5.7 (4.4, 7.3) 7.3 (5.8, 9.1) 14.1 (10.2, 19.5)
Triathlon PS Triathlon 65 2239 1.5 (1.1, 2.2) 2.5 (1.9, 3.3) 3.5 (2.7, 4.5)
Vanguard PS Maxim 21 587 1.5 (0.8, 3.0) 3.5 (2.2, 5.6) 4.6 (2.9, 7.1)
Other (119) 528 6133 2.2 (1.9, 2.7) 6.0 (5.4, 6.7) 7.4 (6.7, 8.1) 10.8 (9.9, 11.8) 13.7 (12.3, 15.2) 13.7 (12.3, 15.2)
TOTAL 4695 133324

a o a .o rg.a u 195
OUTCOME FOR OSTEOARTHRITIS - PATIENT CHARACTERISTICS

Primary total knee replacement has the lowest Age and Gender
rate of revision compared to all other classes of
Age is a major factor affecting the outcome of
primary knee replacement. At 16 years, the
primary total knee replacement. The rate of
cumulative percent revision of primary total
revision decreases with increasing age. This
knee replacement undertaken for osteoarthritis
difference becomes more evident with time.
is 8.0% (Table KT10 and Figure KT8).
Those aged less than 55 years have more than
Reason for Revision three times the rate of revision after nine
months and more than eight times after 9.5
Loosening is the main reason for revision
years compared to those aged 75 years or
(25.9%), followed by infection (22.5%),
older (Table KT13 and Figure KT10).
patellofemoral pain (10.9%), pain (8.6%) and
instability (7.3%) (Table KT11).
Males have a higher rate of revision compared
to females (Table KT14 and Figure KT11).
The aetiology of loosening changes with time.
Loosening reported in the first few years most
Loosening is the most common reason for
likely reflects failure to gain fixation. Loosening
revision in both males and females. Males have
reported in later years is often due to loss of
a higher incidence of revision for infection, with
fixation, secondary to bone resorption.
a 16 year cumulative incidence of 1.7%
compared to 0.9% for females (Figure KT12).
Previously, the Registry has reported
loosening/lysis as a single diagnosis. This
included the diagnoses of loosening or lysis, as
well as loosening and lysis combined. Loosening Males have a higher rate of revision which is
and lysis are now considered separately. The largely due to an increased incidence of
diagnosis of loosening is used when loosening is infection.
reported either alone or in combination with
lysis. The diagnosis of lysis is used for procedures
that report only this diagnosis (Table KT11). Age related differences in the rate of revision
are evident for both males and females (Table
The five most common reasons for revision are KT14, Figures KT13 and KT14).
shown in Figure KT9. Infection is the most
common reason for early revision. Loosening
becomes the most common reason after three
years.
Type of Revision
The most common types of revision are
replacement of both the femoral and tibial
prostheses (25.6%), insert only exchange (21.6%)
and patella only replacement (20.7%) (Table
KT12).

Table KT10 Cumulative Percent Revision of Primary Total Knee Replacement (Primary Diagnosis OA)
N N
Revised Total
Total Knee 19627 534202 1.0 (1.0, 1.1) 2.7 (2.7, 2.8) 3.6 (3.6, 3.7) 5.3 (5.2, 5.4) 7.4 (7.2, 7.6) 8.0 (7.7, 8.3)
TOTAL 19627 534202
Figure KT8 Cumulative Percent Revision of Primary Total Knee Replacement (Primary Diagnosis OA)
24%
Total Knee
22%
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Total Knee 534202 474281 363321 268621 93358 7947 1861

a o a .o rg.a u 197
Table KT11 Primary Total Knee Replacement by Reason Table KT12 Primary Total Knee Replacement by Type of
for Revision (Primary Diagnosis OA) Revision (Primary Diagnosis OA)

Loosening 5074 25.9 TKR (Tibial/Femoral) 5034 25.6
Infection 4412 22.5 Insert Only 4245 21.6
Patellofemoral Pain 2143 10.9 Patella Only 4060 20.7
Pain 1694 8.6 Insert/Patella 1970 10.0
Instability 1429 7.3 Tibial Component 1904 9.7
Patella Erosion 992 5.1 Femoral Component 1145 5.8
Arthrofibrosis 689 3.5 Cement Spacer 1102 5.6
Fracture 541 2.8 Removal of Prostheses 102 0.5
Malalignment 428 2.2 Minor Components 39 0.2
Lysis 389 2.0 Cement Only 9 0.0
Wear Tibial Insert 331 1.7 Reinsertion of Components 9 0.0
Metal Related Pathology 304 1.5 Total Femoral 8 0.0
Incorrect Sizing 239 1.2 TOTAL 19627 100.0
Other 962 4.9
TOTAL 19627 100.0
Figure KT9 Cumulative Incidence Revision Diagnosis of Primary Total Knee Replacement (Primary Diagnosis OA)
5.0%
Loosening
Infection
Patellofemoral Pain
4.0% Pain
Instability
3.0%
2.0%
1.0%
0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Table KT13 Cumulative Percent Revision of Primary Total Knee Replacement by Age (Primary Diagnosis OA)
N N
Revised Total
<55 2645 35261 1.7 (1.6, 1.9) 5.1 (4.8, 5.3) 6.9 (6.6, 7.2) 10.8 (10.4, 11.3) 15.6 (14.7, 16.5) 16.5 (15.2, 18.0)
55-64 6738 140352 1.2 (1.1, 1.3) 3.4 (3.3, 3.5) 4.6 (4.5, 4.7) 7.0 (6.8, 7.2) 10.0 (9.6, 10.4) 11.0 (10.4, 11.6)
65-74 7027 207745 0.9 (0.9, 1.0) 2.5 (2.5, 2.6) 3.4 (3.3, 3.5) 4.9 (4.8, 5.0) 6.4 (6.2, 6.6) 6.8 (6.4, 7.1)
≥75 3217 150844 0.8 (0.8, 0.8) 1.8 (1.7, 1.9) 2.3 (2.2, 2.3) 2.9 (2.8, 3.0) 3.5 (3.3, 3.8) 3.6 (3.3, 3.9)
TOTAL 19627 534202
Figure KT10 Cumulative Percent Revision of Primary Total Knee Replacement by Age (Primary Diagnosis OA)
24% <55 vs ≥75

<55
0 - 6Mth: HR=1.45 (1.25, 1.68),p<0.001
22% 55-64
6Mth - 9Mth: HR=2.90 (2.44, 3.46),p<0.001
65-74
20% ≥75 9Mth - 2Yr: HR=3.50 (3.21, 3.81),p<0.001
2Yr - 2.5Yr: HR=3.31 (2.83, 3.87),p<0.001
18%
2.5Yr - 6.5Yr: HR=3.87 (3.53, 4.23),p<0.001
16% 6.5Yr - 9.5Yr: HR=6.83 (5.69, 8.19),p<0.001

9.5Yr+: HR=8.55 (7.01, 10.42),p<0.001
14%
55 – 64 vs ≥75
12% 0 - 3Mth: HR=0.98 (0.87, 1.12),p=0.808
3Mth - 9Mth: HR=1.63 (1.47, 1.80),p<0.001
10%
9Mth - 4Yr: HR=2.26 (2.14, 2.38),p<0.001
8% 4Yr - 6.5Yr: HR=2.67 (2.40, 2.98),p<0.001
6% 6.5Yr - 7Yr: HR=4.40 (3.43, 5.63),p<0.001

7Yr - 10Yr: HR=4.16 (3.54, 4.88),p<0.001
4% 10Yr+: HR=5.13 (4.26, 6.16),p<0.001
2% 65 – 74 vs ≥75
0 - 6Mth: HR=1.02 (0.92, 1.12),p=0.754
0%
6Mth - 1Yr: HR=1.41 (1.29, 1.54),p<0.001
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1Yr - 2Yr: HR=1.67 (1.56, 1.80),p<0.001
2Yr - 4Yr: HR=1.58 (1.46, 1.69),p<0.001
4Yr - 4.5Yr: HR=2.12 (1.78, 2.53),p<0.001
4.5Yr - 6.5Yr: HR=1.77 (1.58, 1.99),p<0.001
6.5Yr+: HR=2.52 (2.18, 2.92),p<0.001

<55 35261 31196 24006 18023 6857 713 176
55-64 140352 124342 95282 70916 25349 2429 583
65-74 207745 184009 140271 104000 38391 3529 845
≥75 150844 134734 103762 75682 22761 1276 257

a o a .o rg.a u 199
Table KT14 Cumulative Percent Revision of Primary Total Knee Replacement by Gender and Age (Primary Diagnosis OA)
N N
Revised Total
Male 9138 232351 1.2 (1.2, 1.3) 3.0 (2.9, 3.1) 3.9 (3.8, 4.0) 5.8 (5.6, 5.9) 8.1 (7.8, 8.4) 8.7 (8.2, 9.1)
<55 1156 15121 2.1 (1.8, 2.3) 5.4 (5.0, 5.8) 7.0 (6.6, 7.5) 10.8 (10.2, 11.5) 15.3 (14.0, 16.6) 15.8 (14.2, 17.5)
55-64 3283 64030 1.4 (1.3, 1.5) 3.7 (3.5, 3.9) 4.9 (4.7, 5.1) 7.5 (7.2, 7.8) 10.7 (10.2, 11.4) 11.7 (10.7, 12.7)
65-74 3303 92546 1.1 (1.1, 1.2) 2.7 (2.6, 2.9) 3.6 (3.5, 3.7) 5.2 (5.0, 5.4) 6.9 (6.5, 7.3) 7.2 (6.7, 7.8)
≥75 1396 60654 0.9 (0.9, 1.0) 2.0 (1.9, 2.1) 2.5 (2.3, 2.6) 3.3 (3.1, 3.4) 4.1 (3.6, 4.7) 4.1 (3.6, 4.7)
Female 10489 301851 0.9 (0.8, 0.9) 2.5 (2.5, 2.6) 3.4 (3.3, 3.5) 5.0 (4.9, 5.1) 6.9 (6.7, 7.1) 7.5 (7.1, 7.8)
<55 1489 20140 1.5 (1.3, 1.7) 4.8 (4.5, 5.2) 6.9 (6.5, 7.3) 10.8 (10.2, 11.4) 15.8 (14.6, 17.2) 17.2 (15.1, 19.5)
55-64 3455 76322 1.0 (1.0, 1.1) 3.1 (3.0, 3.3) 4.4 (4.2, 4.5) 6.6 (6.4, 6.9) 9.4 (8.9, 9.9) 10.4 (9.6, 11.2)
65-74 3724 115199 0.8 (0.7, 0.8) 2.4 (2.3, 2.5) 3.2 (3.1, 3.3) 4.6 (4.5, 4.8) 6.0 (5.7, 6.3) 6.4 (6.0, 6.9)
≥75 1821 90190 0.7 (0.7, 0.8) 1.7 (1.6, 1.8) 2.1 (2.0, 2.2) 2.7 (2.6, 2.9) 3.2 (3.0, 3.5) 3.3 (3.0, 3.7)
TOTAL 19627 534202
Figure KT11 Cumulative Percent Revision of Primary Total Knee Replacement by Gender (Primary Diagnosis OA)

24%
Male
Male vs Female
22% Female
0 - 9Mth: HR=1.41 (1.32, 1.50),p<0.001
20% 9Mth - 1.5Yr: HR=1.15 (1.08, 1.23),p<0.001
1.5Yr - 2.5Yr: HR=1.04 (0.97, 1.11),p=0.282
18%
2.5Yr - 3.5Yr: HR=0.95 (0.87, 1.04),p=0.278
16% 3.5Yr+: HR=1.10 (1.04, 1.15),p<0.001
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Male 232351 205147 155298 113552 37977 3156 737
Female 301851 269134 208023 155069 55381 4791 1124

Figure KT12 Cumulative Incidence Revision Diagnosis of Primary Total Knee Replacement by Gender (Primary Diagnosis OA)
Male Female
5.0% 5.0%
Loosening Loosening
Infection Infection
Patellofemoral Pain Patellofemoral Pain
4.0% Pain 4.0% Pain
Instability Instability
3.0% 3.0%
2.0% 2.0%
1.0% 1.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Figure KT13 Cumulative Percent Revision of Primary Total Knee Replacement in Males by Age (Primary Diagnosis OA)
24% Male <55 vs Male ≥75

Male <55 0 - 9Mth: HR=1.98 (1.68, 2.33),p<0.001
22% Male 55-64
9Mth - 1Yr: HR=3.22 (2.53, 4.11),p<0.001
Male 65-74
20% Male ≥75 1Yr - 1.5Yr: HR=2.73 (2.25, 3.31),p<0.001
1.5Yr - 2Yr: HR=3.81 (3.09, 4.71),p<0.001
18%
2Yr - 2.5Yr: HR=3.02 (2.35, 3.89),p<0.001
16% 2.5Yr - 3Yr: HR=4.20 (3.22, 5.49),p<0.001

3Yr - 3.5Yr: HR=3.13 (2.29, 4.28),p<0.001
14%
3.5Yr - 9.5Yr: HR=4.02 (3.47, 4.66),p<0.001
12% 9.5Yr+: HR=5.61 (4.41, 7.15),p<0.001
Male 55 – 64 vs Male ≥75
10%
0 - 9Mth: HR=1.43 (1.27, 1.61),p<0.001
8% 9Mth - 1Yr: HR=1.81 (1.50, 2.17),p<0.001
1Yr - 1.5Yr: HR=2.11 (1.84, 2.42),p<0.001
6%
1.5Yr - 4Yr: HR=2.38 (2.14, 2.65),p<0.001
4% 4Yr - 7Yr: HR=2.78 (2.42, 3.20),p<0.001
2% 7Yr - 12Yr: HR=3.25 (2.79, 3.80),p<0.001

12Yr+: HR=3.82 (2.75, 5.31),p<0.001
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
0 - 6Mth: HR=1.15 (1.01, 1.31),p=0.038
6Mth - 1.5Yr: HR=1.35 (1.22, 1.50),p<0.001
1.5Yr - 2.5Yr: HR=1.61 (1.41, 1.83),p<0.001
2.5Yr+: HR=1.84 (1.67, 2.04),p<0.001

Male <55 15121 13330 10310 7826 3021 330 83
55-64 64030 56510 42995 32029 11241 1092 271
65-74 92546 81664 61645 45106 15900 1355 305
≥75 60654 53643 40348 28591 7815 379 78

a o a .o rg.a u 201
Figure KT14 Cumulative Percent Revision of Primary Total Knee Replacement in Females by Age (Primary Diagnosis OA)
24%
Female <55
Female <55 vs Female ≥75
22% Female 55-64
Female 65-74 0 - 9Mth: HR=1.68 (1.42, 1.99),p<0.001
20% Female ≥75 9Mth - 2Yr: HR=3.64 (3.25, 4.09),p<0.001
2Yr - 4Yr: HR=3.84 (3.39, 4.36),p<0.001
18%
4Yr - 7Yr: HR=5.85 (4.94, 6.92),p<0.001
16% 7Yr+: HR=7.17 (6.02, 8.54),p<0.001
14%
Female 55-64 vs Female ≥75
12% 0 - 3Mth: HR=0.83 (0.69, 1.00),p=0.053
3Mth - 9Mth: HR=1.46 (1.26, 1.70),p<0.001
10%
9Mth - 4Yr: HR=2.31 (2.14, 2.49),p<0.001
8% 4Yr+: HR=3.66 (3.24, 4.14),p<0.001
6%
Female 65-74 vs Female ≥75
4% 0 - 9Mth: HR=1.01 (0.90, 1.13),p=0.872
9Mth - 4Yr: HR=1.67 (1.54, 1.80),p<0.001
2%
4Yr - 7.5Yr: HR=2.32 (2.02, 2.66),p<0.001
0% 7.5Yr+: HR=2.16 (1.84, 2.54),p<0.001
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Female <55 20140 17866 13696 10197 3836 383 93
55-64 76322 67832 52287 38887 14108 1337 312
65-74 115199 102345 78626 58894 22491 2174 540
≥75 90190 81091 63414 47091 14946 897 179

OUTCOME FOR OSTEOARTHRITIS - PROSTHESIS CHARACTERISTICS

Fixed and Mobile Bearing
Tibial prostheses are either modular or non- sliding after two years. Rotating prostheses have
modular. Modular prostheses have a metal a lower rate of revision than fixed bearings after
baseplate and tibial insert, which may be fixed eight years. This finding is being reported for the
or mobile. Non-modular prostheses are either first time. There is no difference between fixed
all-polyethylene or polyethylene moulded to a and sliding prostheses. However, the number of
metal baseplate. procedures where a sliding prosthesis has been
used is small (Table KT15 and Figure KT15).
Mobile bearings include inserts that move in
one of three ways: rotating, sliding, or both Moulded non-modular tibial prostheses have
rotating and sliding. Fixed bearings include non- the lowest rate of revision. However, this only
modular tibial prostheses, as well as fixed inserts includes a limited number of prosthesis types.
that do not move relative to the baseplate. There is no difference when comparing all-
polyethylene to fixed modular tibial prostheses
Fixed bearing prostheses have a lower rate of (Table KT16 and Figure KT16).
revision compared to rotating, and rotating-

a o a .o rg.a u 203
Table KT15 Cumulative Percent Revision of Primary Total Knee Replacement by Bearing Mobility (Primary Diagnosis OA)
N N
Bearing Mobility 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Fixed 13968 420701 1.0 (0.9, 1.0) 2.5 (2.5, 2.6) 3.3 (3.3, 3.4) 5.0 (4.9, 5.1) 7.1 (6.9, 7.3) 7.6 (7.3, 8.0)
Rotating 5223 107325 1.2 (1.2, 1.3) 3.5 (3.3, 3.6) 4.6 (4.5, 4.8) 6.3 (6.2, 6.5) 8.2 (7.8, 8.5) 8.8 (8.3, 9.5)
Rotating - Sliding 358 5052 0.9 (0.6, 1.2) 3.0 (2.6, 3.5) 4.5 (3.9, 5.1) 7.2 (6.5, 8.0) 10.2 (9.1, 11.5)
Sliding 72 948 1.7 (1.0, 2.8) 3.4 (2.4, 4.8) 4.4 (3.3, 6.0) 6.7 (5.2, 8.5) 8.0 (6.4, 10.1) 8.9 (6.9, 11.3)
TOTAL 19621 534026
Note: Excludes 176 procedures with unknown bearing mobility
Figure KT15 Cumulative Percent Revision of Primary Total Knee Replacement by Bearing Mobility (Primary Diagnosis OA)

24%
Fixed
Rotating vs Fixed
22% Rotating
Rotating - Sliding 0 - 1Yr: HR=1.23 (1.16, 1.31),p<0.001
20% Sliding 1Yr - 1.5Yr: HR=1.50 (1.38, 1.63),p<0.001
1.5Yr - 2Yr: HR=1.28 (1.16, 1.42),p<0.001
18%
2Yr - 2.5Yr: HR=1.40 (1.25, 1.56),p<0.001
16% 2.5Yr - 3Yr: HR=1.50 (1.32, 1.70),p<0.001
14% 3Yr - 5Yr: HR=1.41 (1.31, 1.53),p<0.001

5Yr - 8Yr: HR=1.09 (1.00, 1.20),p=0.060
12%
8Yr+: HR=0.81 (0.73, 0.91),p<0.001
10%
Rotating - Sliding vs Fixed
8% 0 - 2Yr: HR=1.12 (0.93, 1.35),p=0.242
6% 2Yr+: HR=1.53 (1.34, 1.73),p<0.001
4% Sliding vs Fixed
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Fixed 420701 369794 277613 200607 66495 5504 1288
Rotating 107325 98632 80271 63006 23505 1980 402
Rotating - Sliding 5052 4764 4419 4046 2592 118 6
Sliding 948 925 883 846 711 340 163

Table KT16 Cumulative Percent Revision of Fixed Primary Total Knee Replacement by Bearing Type (Primary Diagnosis OA)
N N
Fixed Bearing Type 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
All-Polyethylene 66 1496 0.5 (0.2, 1.0) 2.7 (1.9, 3.7) 4.0 (3.0, 5.3) 5.5 (4.3, 7.0)
Moulded Non-Modular 675 21645 0.6 (0.5, 0.7) 1.9 (1.8, 2.1) 2.7 (2.5, 3.0) 4.2 (3.9, 4.6) 6.5 (5.7, 7.4) 8.8 (6.6, 11.6)
Fixed Modular 13227 397560 1.0 (1.0, 1.0) 2.5 (2.5, 2.6) 3.4 (3.3, 3.4) 5.0 (4.9, 5.1) 7.2 (6.9, 7.4) 7.5 (7.3, 7.8)
TOTAL 13968 420701
Figure KT16 Cumulative Percent Revision of Fixed Primary Total Knee Replacement by Bearing Type (Primary Diagnosis OA)

24%
All-Polyethylene
All-Polyethylene vs Moulded Non-Modular
22% Moulded Non-Modular
Fixed Modular Entire Period: HR=1.49 (1.16, 1.92),p=0.002
20%
Fixed Modular vs Moulded Non-Modular
18% 0 - 2Wk: HR=2.50 (1.03, 6.06),p=0.043
16% 2Wk - 1Mth: HR=5.23 (2.17, 12.63),p<0.001

1Mth - 1.5Yr: HR=1.44 (1.25, 1.65),p<0.001
14%
1.5Yr+: HR=1.11 (1.02, 1.22),p=0.021
12%
All-Polyethylene vs Fixed Modular
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

All-Polyethylene 1496 1333 1128 1030 630 24 2
Moulded Non-Modular 21645 20469 17098 12830 4033 344 95
Fixed Modular 397560 347992 259387 186747 61832 5136 1191

a o a .o rg.a u 205
Stability
Stability refers to particular prosthetic features additional collateral, as well as posterior
intended to substitute for the intrinsic stability ligament stability. These prostheses are used in
of knee ligaments. This year, the Registry has 0.5% of primary procedures (Table KT17). They
expanded the classification to include the are usually used in complex clinical situations
medial pivot designs separately. The three and have therefore been excluded from any
major categories are now: minimally stabilised, comparative outcome analysis for primary
medial pivot and posterior stabilised. total knee replacement.
Posterior stabilised and medial pivot

Medial pivot primary total knee prostheses have a higher rate of revision
replacement is included as a separate compared to minimally stabilised (Table KT17
category for the first time. and Figure KT18). The cumulative incidence for
the different reasons for revision varies
depending on stability. Posterior stabilised
The Registry defines minimally stabilised prostheses have a higher cumulative
prostheses as those that have a flat or dished incidence of infection compared to minimally
tibial articulation, regardless of congruency. stabilised and medial pivot prostheses.
Medial pivot prostheses are minimally Posterior stabilised also have a higher
stabilised, but have a ball-and-socket medial cumulative incidence of loosening compared
portion of the articulation. Posterior stabilised to minimally stabilised prostheses. Medial pivot
prostheses provide additional posterior prostheses have a higher cumulative
stability, most commonly using a peg and box incidence of revision for pain and instability
design, or less frequently, a cam and groove. compared to minimally stabilised prostheses
(Figure KT19).
Comparing minimally stabilised, posterior
stabilised and medial pivot primary total knee As with minimally stabilised and posterior
replacement, the use of minimally stabilised stabilised prostheses, there is a variation in the
prostheses has remained relatively constant rate of revision when different prostheses are
over the last 10 years. In 2016, these compared within the medial pivot group. This
accounted for 67.4% of the three prosthesis group only contains five prostheses. One of
types. The use of posterior stabilised prostheses these, the Advance, is identified as a
has declined from 32.9% in 2008 to 25.6% in prosthesis with a higher than anticipated rate
2016. Medial pivot total knee replacements of revision (Table KT18). When the Advance is
have been used in small numbers since the excluded from the analysis comparing
Registry began collecting data. In 2016 this minimally stabilised and medial pivot
has increased, accounting for 7.0% (Figure prostheses, there is no difference between
KT17). these two groups. However, the follow up for
the medial pivot group is only four years when
Fully stabilised (large peg and box design) and the Advance is excluded (Table KT19 and
hinged, are less used prostheses that provide Figure KT20).

Figure KT17 Primary Total Knee Replacement by Stability (Primary Diagnosis OA)
100%
Minimally Stabilised
90% Posterior Stabilised
Medial Pivot
80%
70%
60%
50%
40%
30%
20%
10%
0%
03
04
05
06
07
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
20
20
20
20
20
Table KT17 Cumulative Percent Revision of Primary Total Knee Replacement by Stability (Primary Diagnosis OA)
N N
Stability 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Minimally Stabilised 13511 379445 0.9 (0.9, 1.0) 2.6 (2.5, 2.6) 3.4 (3.3, 3.5) 5.0 (4.9, 5.1) 7.1 (6.9, 7.3) 7.7 (7.4, 8.1)
Posterior Stabilised 5786 142780 1.2 (1.2, 1.3) 3.1 (3.0, 3.2) 4.1 (4.0, 4.2) 6.1 (5.9, 6.3) 8.1 (7.6, 8.6) 8.4 (7.8, 9.1)
Medial Pivot 200 9390 1.2 (0.9, 1.4) 3.0 (2.5, 3.5) 3.8 (3.2, 4.6) 6.4 (5.3, 7.8) 7.5 (5.9, 9.5)
Fully Stabilised 83 1777 2.3 (1.7, 3.2) 4.4 (3.5, 5.6) 5.8 (4.6, 7.3) 7.8 (6.0, 10.2)
Hinged 41 634 2.5 (1.5, 4.1) 5.4 (3.7, 7.8) 7.1 (5.0, 10.0)
TOTAL 19621 534026
Note: Excludes 176 procedures with unknown stability
Figure KT18 Cumulative Percent Revision of Primary Total Knee Replacement by Stability (Primary Diagnosis OA)

24%
Minimally Stabilised
Posterior Stabilised vs Minimally Stabilised
Medial Pivot 0 - 1Yr: HR=1.28 (1.21, 1.36),p<0.001
20% 1Yr - 2Yr: HR=1.09 (1.02, 1.16),p=0.010
2Yr - 2.5Yr: HR=1.32 (1.19, 1.47),p<0.001
18%
2.5Yr+: HR=1.19 (1.14, 1.25),p<0.001
16%
Medial Pivot vs Minimally Stabilised
14%
12%
Posterior Stabilised vs Medial Pivot
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Minimally Stabilised 379445 339252 262727 195578 73965 6970 1655
Posterior Stabilised 142780 127197 97163 70937 18639 875 196
Medial Pivot 9390 5727 2047 1191 531 77 7

a o a .o rg.a u 207
Figure KT19 Cumulative Incidence Revision Diagnosis of Primary Total Knee Replacement by Stability (Primary Diagnosis OA)
Minimally Stabilised Posterior Stabilised
5.0% 5.0%
Loosening Loosening
Infection Infection
4.0% Pain 4.0% Pain
3.0% 3.0%
2.0% 2.0%
1.0% 1.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Medial Pivot
5.0%
Loosening
Infection
Patellofemoral Pain
4.0% Pain
Instability
3.0%
2.0%
1.0%
0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Table KT18 Cumulative Percent Revision of Primary Total Knee Replacement with Medial Pivot by Insert (Primary Diagnosis
OA)
N N
Insert Component 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Advance I 5 15 6.7 (1.0, 38.7) 13.3 (3.5, 43.6) 13.3 (3.5, 43.6) 35.0 (16.3, 64.9) 35.0 (16.3, 64.9) 35.0 (16.3, 64.9)
Advance II 103 1610 1.9 (1.3, 2.7) 4.3 (3.4, 5.5) 5.3 (4.3, 6.5) 7.5 (6.2, 9.2) 8.6 (6.8, 10.8)
Evolution 31 3087 0.7 (0.4, 1.2) 2.2 (1.5, 3.4)
GMK Sphere Primary 50 3361 1.2 (0.9, 1.8) 2.7 (2.0, 3.7)
SAIPH 11 1317 0.6 (0.2, 1.2) 1.6 (0.8, 3.1)
TOTAL 200 9390

Table KT19 Cumulative Percent Revision of Primary Total Knee Replacement by Stability (Primary Diagnosis OA, Excluding
Advance)
N N
Revised Total
Minimally Stabilised 13511 379445 0.9 (0.9, 1.0) 2.6 (2.5, 2.6) 3.4 (3.3, 3.5) 5.0 (4.9, 5.1) 7.1 (6.9, 7.3) 7.7 (7.4, 8.1)
Posterior Stabilised 5786 142780 1.2 (1.2, 1.3) 3.1 (3.0, 3.2) 4.1 (4.0, 4.2) 6.1 (5.9, 6.3) 8.1 (7.6, 8.6) 8.4 (7.8, 9.1)
Medial Pivot 92 7765 0.9 (0.7, 1.2) 2.4 (1.9, 3.0)
Fully Stabilised 83 1777 2.3 (1.7, 3.2) 4.4 (3.5, 5.6) 5.8 (4.6, 7.3) 7.8 (6.0, 10.2)
Hinged 41 634 2.5 (1.5, 4.1) 5.4 (3.7, 7.8) 7.1 (5.0, 10.0)
TOTAL 19513 532401
Note: Excludes 176 procedures with unknown stability
Figure KT20 Cumulative Percent Revision of Primary Total Knee Replacement by Stability (Primary Diagnosis OA, Excluding
Advance)

24%
Minimally Stabilised Posterior Stabilised vs Minimally Stabilised
0 - 1Yr: HR=1.28 (1.21, 1.36),p<0.001
Medial Pivot
20% 1Yr - 2Yr: HR=1.09 (1.02, 1.16),p=0.008
2Yr - 2.5Yr: HR=1.32 (1.18, 1.47),p<0.001
18%
2.5Yr+: HR=1.19 (1.14, 1.25),p<0.001
16%
Medial Pivot vs Minimally Stabilised
12%
Posterior Stabilised vs Medial Pivot
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Minimally Stabilised 379445 339252 262727 195578 73965 6970 1655
Posterior Stabilised 142780 127197 97163 70937 18639 875 196
Medial Pivot 7765 4168 611 26 0 0 0

a o a .o rg.a u 209
Patellar Resurfacing
Resurfacing the patella has a lower rate of When the patella is resurfaced, there is no
revision compared to procedures without difference in the rate of revision of medial
patellar resurfacing (Table KT20 and Figure pivot prostheses compared to minimally
KT21). stabilised prostheses. When the patella is not
resurfaced, medial pivot knees have a higher
When resurfacing the patella, the rate of rate of revision than minimally stabilised knees
revision is lower for minimally stabilised (Table KT21 and Figure KT23).
compared to posterior stabilised prostheses
within the first 3.5 years. Posterior stabilised Outcomes related to the use of patellar
without patellar resurfacing has the highest resurfacing vary depending on the type of
rate of revision (Table KT21 and Figure KT22). prosthesis used.
Table KT20 Cumulative Percent Revision of Primary Total Knee Replacement by Patella Usage (Primary Diagnosis OA)
N N
Patella Usage 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Patella Used 8058 275454 0.9 (0.9, 0.9) 2.2 (2.2, 2.3) 3.0 (2.9, 3.1) 4.6 (4.5, 4.7) 6.7 (6.4, 7.0) 7.0 (6.6, 7.4)
No Patella 11569 258748 1.1 (1.1, 1.2) 3.2 (3.1, 3.3) 4.2 (4.1, 4.3) 6.0 (5.9, 6.1) 8.0 (7.8, 8.3) 8.8 (8.4, 9.2)
TOTAL 19627 534202
Figure KT21 Cumulative Percent Revision of Primary Total Knee Replacement by Patella Usage (Primary Diagnosis OA)

24%
Patella Used
No Patella vs Patella Used
22% No Patella
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Patella Used 275454 238631 174642 123650 40127 3194 599
No Patella 258748 235650 188679 144971 53231 4753 1262

Table KT21 Cumulative Percent Revision of Primary Total Knee Replacement by Stability and Patella Usage (Primary Diagnosis
OA)
Patella N N
Usage Revised Total
Minimally Stabilised Patella Used 4821 169427 0.8 (0.8, 0.9) 2.1 (2.0, 2.1) 2.8 (2.7, 2.9) 4.3 (4.2, 4.5) 6.5 (6.2, 6.9) 6.9 (6.4, 7.4)
No Patella 8690 210018 1.0 (1.0, 1.1) 2.9 (2.9, 3.0) 3.9 (3.8, 4.0) 5.6 (5.4, 5.7) 7.5 (7.3, 7.8) 8.3 (7.9, 8.7)
Posterior Stabilised Patella Used 3114 99747 1.0 (1.0, 1.1) 2.5 (2.4, 2.6) 3.4 (3.2, 3.5) 5.1 (4.9, 5.3) 6.6 (6.1, 7.0) 6.6 (6.1, 7.0)
No Patella 2672 43033 1.6 (1.5, 1.8) 4.3 (4.2, 4.6) 5.7 (5.4, 5.9) 7.9 (7.6, 8.2) 10.5 (9.6, 11.5) 11.2 (9.9, 12.6)
Medial Pivot Patella Used 56 4715 0.9 (0.7, 1.3) 1.8 (1.3, 2.4) 2.5 (1.7, 3.5) 3.2 (2.1, 4.9)
No Patella 144 4675 1.4 (1.0, 1.8) 4.0 (3.3, 4.9) 5.0 (4.1, 6.0) 8.0 (6.5, 9.8) 9.3 (7.3, 11.7)
TOTAL 19497 531615
Figure KT22 Cumulative Percent Revision of Primary Total Knee Replacement by Stability and Patella Usage (Primary Diagnosis
OA)
24% Minimally Stabilised Patella Used vs
Minimally Stabilised Patella Used
Minimally Stabilised No Patella
22% Minimally Stabilised No Patella
Posterior Stabilised Patella Used Entire Period: HR=0.78 (0.75, 0.80),p<0.001
20% Posterior Stabilised No Patella Minimally Stabilised No Patella vs
Posterior Stabilised No Patella
18%
0 - 1.5Yr: HR=0.64 (0.60, 0.68),p<0.001
16% 1.5Yr - 2Yr: HR=0.72 (0.63, 0.82),p<0.001
14% 2Yr - 3.5Yr: HR=0.67 (0.61, 0.73),p<0.001

3.5Yr - 4Yr: HR=0.57 (0.47, 0.69),p<0.001
12% 4Yr+: HR=0.78 (0.72, 0.85),p<0.001
10% Minimally Stabilised Patella Used vs

Posterior Stabilised Patella Used
8%
0 - 2Yr: HR=0.82 (0.78, 0.87),p<0.001
6% 2Yr - 2.5Yr: HR=0.74 (0.65, 0.83),p<0.001
2.5Yr - 3Yr: HR=0.86 (0.75, 0.99),p=0.035
4%
3Yr - 3.5Yr: HR=0.80 (0.69, 0.94),p=0.005
2% 3.5Yr - 4Yr: HR=0.91 (0.77, 1.08),p=0.296
4Yr - 4.5Yr: HR=0.88 (0.73, 1.06),p=0.169
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 4.5Yr+: HR=1.05 (0.97, 1.13),p=0.216
Posterior Stabilised Patella Used vs
Posterior Stabilised No Patella

Minimally Stabilised Patella Used 169427 147740 109628 78942 29172 2703 496
No Patella 210018 191512 153099 116636 44793 4267 1159
Posterior Stabilised Patella Used 99747 86914 63411 43856 10755 474 102
No Patella 43033 40283 33752 27081 7884 401 94

a o a .o rg.a u 211
Figure KT23 Cumulative Percent Revision of Primary Total Knee Replacement by Stability and Patella Usage (Primary Diagnosis
OA)

24%
Minimally Stabilised Patella Used Minimally Stabilised Patella Used vs
22% Minimally Stabilised No Patella
Minimally Stabilised No Patella
Medial Pivot Patella Used
20% Medial Pivot No Patella Entire Period: HR=0.77 (0.75, 0.80),p<0.001
18% Minimally Stabilised No Patella vs

Medial Pivot No Patella

16%
14%
Minimally Stabilised Patella Used vs
12%
Medial Pivot Patella Used
8% Medial Pivot Patella Used vs

6% Medial Pivot No Patella
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Minimally Stabilised Patella Used 169427 147740 109628 78942 29172 2703 496
No Patella 210018 191512 153099 116636 44793 4267 1159
Medial Pivot Patella Used 4715 2738 863 396 103 5 0
No Patella 4675 2989 1184 795 428 72 7

Fixation
Cementing the tibial component gives the
The effect of fixation varies depending on best outcome for minimally stabilised and
implant stability. medial pivot prostheses. Cementing both
tibial and femoral components gives the
With a minimally stabilised prosthesis, there is no best outcome for posterior stabilised
difference between cemented and hybrid prostheses.
fixation and both have a lower rate of revision
compared to cementless fixation (Table KT22
and Figure KT24).
When a medial pivot prosthesis is used there is a
When a posterior stabilised knee is used, similar outcome to minimally stabilised
cemented fixation has a lower rate of revision prostheses with respect to fixation. There is no
compared to hybrid fixation and when difference between cemented and hybrid
compared to cementless fixation within the first fixation and both have a lower rate of revision
1.5 years. Hybrid fixation has a higher rate of compared to cementless fixation (Table KT24
revision compared to both cemented and and Figure KT26).
cementless fixation (Table KT23 and Figure
KT25).
Table KT22 Cumulative Percent Revision of Minimally Stabilised Primary Total Knee Replacement by Fixation (Primary
Diagnosis OA)
N N
Revised Total
Cemented 4712 157680 0.8 (0.8, 0.9) 2.2 (2.1, 2.3) 2.9 (2.9, 3.0) 4.5 (4.3, 4.6) 6.5 (6.2, 6.9) 6.9 (6.5, 7.3)
Cementless 4795 102625 1.2 (1.1, 1.2) 3.2 (3.0, 3.3) 4.2 (4.1, 4.4) 6.1 (5.9, 6.3) 8.5 (8.1, 8.9) 9.6 (8.9, 10.3)
Hybrid 3804 118721 0.8 (0.8, 0.9) 2.3 (2.2, 2.4) 3.1 (3.0, 3.2) 4.6 (4.4, 4.7) 6.4 (6.1, 6.7) 7.0 (6.4, 7.6)
TOTAL 13311 379026
Note: Excluding cementless Genesis Oxinium and Profix Oxinium femoral prostheses
Figure KT24 Cumulative Percent Revision of Minimally Stabilised Primary Total Knee Replacement by Fixation (Primary
Diagnosis OA)

24%
Cemented Cementless vs Cemented
22% Cementless
Hybrid
20%
Hybrid vs Cemented
16% Cementless vs Hybrid

12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Cemented 157680 137324 102690 75175 27902 2835 658
Cementless 102625 95177 78385 60395 22089 1754 451
Hybrid 118721 106395 81421 59789 23799 2381 546

a o a .o rg.a u 213
Table KT23 Cumulative Percent Revision of Posterior Stabilised Primary Total Knee Replacement by Fixation (Primary Diagnosis
OA)
N N
Revised Total
Cemented 4774 124375 1.1 (1.1, 1.2) 2.9 (2.8, 3.0) 3.9 (3.8, 4.1) 5.9 (5.8, 6.1) 7.8 (7.3, 8.3) 8.0 (7.3, 8.8)
Cementless 337 6947 1.9 (1.6, 2.2) 4.0 (3.5, 4.5) 5.0 (4.5, 5.6) 6.3 (5.6, 7.1)
Hybrid 675 11458 1.6 (1.4, 1.8) 4.2 (3.8, 4.6) 5.5 (5.1, 6.0) 7.3 (6.7, 7.9) 10.3 (9.0, 11.8) 10.9 (9.3, 12.8)
TOTAL 5786 142780
Figure KT25 Cumulative Percent Revision of Posterior Stabilised Primary Total Knee Replacement by Fixation (Primary Diagnosis
OA)

24%
22% Cementless
0 - 1.5Yr: HR=1.36 (1.17, 1.59),p<0.001
Hybrid
20% 1.5Yr+: HR=0.89 (0.76, 1.05),p=0.163
18% Hybrid vs Cemented


16%
14% Hybrid vs Cementless

12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Cemented 124375 110276 83217 59991 15594 689 140
Cementless 6947 6351 5132 3930 769 12 2
Hybrid 11458 10570 8814 7016 2276 174 54

Table KT24 Cumulative Percent Revision of Medial Pivot Primary Total Knee Replacement by Fixation (Primary Diagnosis OA)
N N
Revised Total
Cemented 144 8497 1.0 (0.8, 1.3) 2.8 (2.3, 3.4) 3.4 (2.8, 4.3) 6.9 (5.0, 9.3) 9.0 (6.0, 13.3)
Cementless 35 483 3.2 (1.9, 5.2) 5.9 (4.1, 8.5) 6.8 (4.9, 9.5) 7.9 (5.7, 11.0)
Hybrid 21 410 1.0 (0.4, 2.7) 2.3 (1.2, 4.4) 3.5 (2.1, 6.0) 6.4 (4.1, 9.9)
TOTAL 200 9390
Figure KT26 Cumulative Percent Revision of Medial Pivot Primary Total Knee Replacement by Fixation (Primary Diagnosis OA)

24%
22% Cementless
0 - 6Mth: HR=0.56 (0.08, 4.10),p=0.567
Hybrid
20% 6Mth - 2Yr: HR=3.11 (2.01, 4.79),p<0.001
2Yr+: HR=0.43 (0.19, 0.98),p=0.043
18%
Hybrid vs Cemented
16%
14%
12%
0 - 9Mth: HR=2.91 (1.25, 6.80),p=0.013
10% 9Mth - 2Yr: HR=2.76 (1.40, 5.44),p=0.003
2Yr+: HR=0.46 (0.19, 1.09),p=0.078
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Cemented 8497 4881 1263 547 197 42 6
Cementless 483 456 428 343 176 31 1
Hybrid 410 390 356 301 158 4 0

a o a .o rg.a u 215
Computer Navigation Image Derived Instrumentation (IDI)

There have been 96,730 primary total knee There have been 20,931 primary total knee
replacement procedures reported to the replacement procedures undertaken using IDI
Registry in which computer navigation was since 2009. In 2016, IDI was used in 10.4% of all
used. In 2016, computer navigation was used in primary total knee replacement procedures.
30.8% of all primary total knee replacement
procedures. There is a lower rate of revision in the first three
months when IDI is used compared to non IDI.
Patients aged less than 65 years have a lower From three months to 1.5 years this is reversed
rate of revision when computer navigation is and there is a higher rate of revision. After this
used. There is no difference in the rate of time, there is no difference in the rate of revision
revision for the 65 years or older age group between IDI and non IDI (Table KT26 and Figure
(Table KT25 and Figure KT27). However, there is KT29).
a reduction in the rate of revision for navigated
knee replacement due to loosening in both The difference is age dependent and there is
age groups (Figure KT28). no difference in patients aged less than 65
years. However, there is an increased rate of
revision for patients aged 65 years or older after
three months (Table KT27 and Figure KT30).
Table KT25 Cumulative Percent Revision of Primary Total Knee Replacement by Computer Navigation and Age (Primary
Diagnosis OA)
N N
Navigation Age 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Computer Navigated 2582 96730 1.0 (0.9, 1.0) 2.6 (2.4, 2.7) 3.4 (3.3, 3.5) 5.1 (4.8, 5.4)
<65 1195 34089 1.1 (1.0, 1.2) 3.2 (3.0, 3.4) 4.4 (4.2, 4.7) 7.1 (6.5, 7.7)
≥65 1387 62641 0.9 (0.8, 1.0) 2.2 (2.1, 2.3) 2.8 (2.7, 3.0) 4.0 (3.7, 4.3)
Non Navigated 17045 437472 1.0 (1.0, 1.1) 2.8 (2.7, 2.8) 3.7 (3.6, 3.7) 5.4 (5.3, 5.5) 7.4 (7.2, 7.6) 8.0 (7.7, 8.3)
<65 8188 141524 1.4 (1.3, 1.4) 3.8 (3.7, 3.9) 5.2 (5.1, 5.3) 7.9 (7.7, 8.1) 11.3 (11.0, 11.7) 12.3 (11.7, 12.9)
≥65 8857 295948 0.9 (0.8, 0.9) 2.2 (2.2, 2.3) 2.9 (2.8, 3.0) 4.1 (4.0, 4.2) 5.3 (5.1, 5.5) 5.6 (5.3, 5.9)
TOTAL 19627 534202

Figure KT27 Cumulative Percent Revision of Primary Total Knee Replacement by Computer Navigation and Age (Primary
Diagnosis OA) HR - adjusted for gender
Computer Navigated <65 vs Computer Navigated ≥65
24% 0 - 3Mth: HR=1.10 (0.90, 1.35),p=0.367
Computer Navigated <65
22% Computer Navigated ≥65 3Mth - 9Mth: HR=1.26 (1.06, 1.50),p=0.010
Non Navigated <65 9Mth - 1Yr: HR=1.54 (1.23, 1.92),p<0.001
20% Non Navigated ≥65 1Yr - 2Yr: HR=1.44 (1.26, 1.63),p<0.001
18% 2Yr - 2.5Yr: HR=1.98 (1.64, 2.40),p<0.001
2.5Yr - 3.5Yr: HR=1.60 (1.33, 1.93),p<0.001
16%
3.5Yr+: HR=2.08 (1.82, 2.37),p<0.001
14% Computer Navigated ≥65 vs Non Navigated ≥65
12%
Computer Navigated <65 vs Non Navigated <65
Non Navigated ≥65 vs Non Navigated <65
8%
0 - 2Wk: HR=0.95 (0.75, 1.20),p=0.679
6% 2Wk - 1Mth: HR=0.98 (0.83, 1.17),p=0.850
1Mth - 3Mth: HR=0.89 (0.77, 1.03),p=0.103
4%
3Mth - 9Mth: HR=0.61 (0.56, 0.67),p<0.001
2% 9Mth - 1.5Yr: HR=0.54 (0.50, 0.57),p<0.001
0% 1.5Yr - 3Yr: HR=0.53 (0.50, 0.56),p<0.001

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 3Yr - 3.5Yr: HR=0.51 (0.45, 0.58),p<0.001
Years Since Primary Procedure 3.5Yr - 4.5Yr: HR=0.49 (0.44, 0.55),p<0.001
4.5Yr - 5Yr: HR=0.48 (0.40, 0.56),p<0.001
5Yr - 6.5Yr: HR=0.48 (0.43, 0.54),p<0.001
6.5Yr - 7Yr: HR=0.37 (0.29, 0.46),p<0.001
7Yr - 11Yr: HR=0.41 (0.37, 0.45),p<0.001
11Yr+: HR=0.33 (0.28, 0.39),p<0.001
Figure KT28 Cumulative Percent Revision for Loosening of Primary Total Knee Replacement by Computer Navigation and Age

24%
Computer Navigated <65
Computer Navigated <65 vs
22% Computer Navigated ≥65
Non Navigated <65 Computer Navigated ≥65
20% Non Navigated ≥65 0 - 2.5Yr: HR=1.64 (1.33, 2.02),p<0.001
2.5Yr+: HR=2.47 (1.95, 3.12),p<0.001
18%
16% Computer Navigated ≥65 vs Non Navigated ≥65

14%
Computer Navigated <65 vs Non Navigated <65
12%
10%
Non Navigated <65 vs Non Navigated ≥65
8%
0 - 1Mth: HR=0.82 (0.49, 1.35),p=0.426
6% 1Mth - 6Mth: HR=1.75 (1.37, 2.25),p<0.001

6Mth - 9Mth: HR=1.90 (1.50, 2.41),p<0.001
4%
9Mth - 1.5Yr: HR=2.18 (1.92, 2.47),p<0.001
2% 1.5Yr - 2Yr: HR=2.00 (1.67, 2.39),p<0.001
2Yr - 3Yr: HR=2.16 (1.87, 2.50),p<0.001
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 3Yr+: HR=2.74 (2.51, 2.99),p<0.001

Computer Navigated 96730 79680 51117 30907 3363 0 0
<65 34089 28102 18327 11418 1284 0 0
≥65 62641 51578 32790 19489 2079 0 0
Non Navigated 437472 394601 312204 237714 89995 7947 1861
<65 141524 127436 100961 77521 30922 3142 759
≥65 295948 267165 211243 160193 59073 4805 1102

a o a .o rg.a u 217
Table KT26 Cumulative Percent Revision of Primary Total Knee Replacement since 2009 by IDI Usage (Primary Diagnosis OA)
N N
IDI Usage 1 Yr 2 Yrs 3 Yrs 4 Yrs 5 Yrs 6 Yrs
Revised Total
IDI Used 474 20931 1.1 (0.9, 1.3) 2.2 (2.0, 2.5) 2.9 (2.7, 3.2) 3.5 (3.2, 3.8) 3.9 (3.5, 4.3) 4.3 (3.8, 4.8)
No IDI 8263 321519 1.0 (0.9, 1.0) 1.9 (1.9, 2.0) 2.6 (2.5, 2.6) 3.0 (2.9, 3.1) 3.4 (3.3, 3.4) 3.7 (3.6, 3.8)
TOTAL 8737 342450
Figure KT29 Cumulative Percent Revision of Primary Total Knee Replacement since 2009 by IDI Usage (Primary Diagnosis OA)

24%
IDI Used IDI Used vs No IDI
22% No IDI
0 - 3Mth: HR=0.65 (0.48, 0.87),p=0.003
20% 3Mth - 1.5Yr: HR=1.26 (1.10, 1.43),p<0.001

1.5Yr+: HR=1.09 (0.94, 1.27),p=0.242
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7

IDI Used 20931 15350 10842 7685 4819 2608 751
No IDI 321519 271171 222122 176743 135375 96671 61075

Table KT27 Cumulative Percent Revision of Primary Total Knee Replacement since 2009 by IDI Usage and Age (Primary
Diagnosis OA)
N N
IDI Usage Age 1 Yr 2 Yrs 3 Yrs 4 Yrs 5 Yrs 6 Yrs
Revised Total
IDI Used 474 20931 1.1 (0.9, 1.3) 2.2 (2.0, 2.5) 2.9 (2.7, 3.2) 3.5 (3.2, 3.8) 3.9 (3.5, 4.3) 4.3 (3.8, 4.8)
<65 230 7890 1.5 (1.2, 1.8) 2.9 (2.5, 3.3) 3.6 (3.2, 4.2) 4.4 (3.8, 5.0) 4.7 (4.1, 5.4) 5.3 (4.5, 6.2)
≥65 244 13041 0.8 (0.7, 1.0) 1.9 (1.6, 2.1) 2.5 (2.2, 2.9) 2.9 (2.5, 3.3) 3.3 (2.9, 3.8) 3.6 (3.0, 4.3)
No IDI 8263 321519 1.0 (0.9, 1.0) 1.9 (1.9, 2.0) 2.6 (2.5, 2.6) 3.0 (2.9, 3.1) 3.4 (3.3, 3.4) 3.7 (3.6, 3.8)
<65 3812 109761 1.2 (1.1, 1.3) 2.5 (2.4, 2.6) 3.4 (3.3, 3.5) 4.0 (3.9, 4.2) 4.5 (4.4, 4.7) 5.0 (4.8, 5.2)
≥65 4451 211758 0.9 (0.8, 0.9) 1.7 (1.6, 1.7) 2.1 (2.1, 2.2) 2.5 (2.4, 2.5) 2.7 (2.7, 2.8) 3.0 (2.9, 3.1)
TOTAL 8737 342450
Figure KT30 Cumulative Percent Revision of Primary Total Knee Replacement since 2009 by IDI Usage and Age (Primary
Diagnosis OA)

24%
IDI Used <65 IDI Used <65 vs IDI Used ≥65
22% IDI Used ≥65
No IDI <65
20% No IDI ≥65
IDI Used ≥65 vs No IDI ≥65
18% 0 - 3Mth: HR=0.65 (0.55, 0.77),p<0.001
16% 3Mth - 1.5Yr: HR=1.22 (1.06, 1.40),p=0.004

1.5Yr+: HR=1.31 (1.15, 1.51),p<0.001
14%
IDI Used <65 vs No IDI <65
12%
10%
No IDI <65 vs No IDI ≥65
8%
0 - 3Mth: HR=0.90 (0.79, 1.02),p=0.093
6% 3Mth - 2Yr: HR=1.68 (1.58, 1.78),p<0.001
2Yr+: HR=1.89 (1.76, 2.03),p<0.001
4%
2%
0%
0 1 2 3 4 5 6 7

IDI Used 20931 15350 10842 7685 4819 2608 751
<65 7890 5881 4213 3073 1925 1066 326
≥65 13041 9469 6629 4612 2894 1542 425
No IDI 321519 271171 222122 176743 135375 96671 61075
<65 109761 92770 76352 61429 47580 34657 22020
≥65 211758 178401 145770 115314 87795 62014 39055

a o a .o rg.a u 219
Bearing Surface
There are two tibial bearing surfaces used in There is the potential for the difference
primary total knee replacement procedures: between XLPE and non XLPE to be
cross-linked polyethylene (XLPE ) and non confounded by prosthesis use. To address this
cross-linked polyethylene (non XLPE). XLPE has issue, an analysis was undertaken to compare
been classified as ultrahigh molecular weight the rate of revision for specific prostheses that
polyethylene that has been irradiated by high have used both XLPE and non XLPE bearings in
dose (50kGy) gamma or electron beam at least 500 procedures.
radiation. XLPE also includes 10,091
procedures that have used XLPE with the There were 16 prosthesis combinations in this
addition of an antioxidant. XLPE is now used analysis. The rate of revision was lower when
more frequently (57.0% in 2016) than non XLPE. XLPE was used for three of these prostheses.
There was no difference in rate of revision for
It has previously been reported that when the remaining prostheses (Tables KT30 and
comparing all prostheses using XLPE to those KT31).
using non XLPE, the XLPE group has a lower
Prosthesis Specific (Antioxidant)
rate of revision. This year’s analysis again
confirms that finding. Prostheses using XLPE For the first time, an analysis comparing the
have a cumulative percent revision rate of rate of revision of XLPE and XLPE + antioxidant
3.7% at 10 years, compared to 5.7% for non has been undertaken. The follow up for XLPE +
XLPE (Table KT28 and Figure KT31). The major antioxidant is relatively short (five years). XLPE
reason for this difference is a reduced + antioxidant has a lower rate of revision
cumulative incidence for loosening (0.7% at 10 (Table KT32 and Figure KT34). However, there
years for XLPE compared to 1.5% for non XLPE) are only a small number of prostheses that use
(Figure KT32). this bearing. The Attune was used in over 80%
of these procedures. When the Attune is
The overall difference between XLPE and non excluded from the analysis, there is no
XLPE is more evident in younger patients. The difference between XLPE and XLPE +
10 year cumulative percent revision rate for antioxidant (Figure KT35).
those aged less than 65 years for XLPE is 5.2%
and for non XLPE is 8.4%. For those aged 65
years or older the 10 year cumulative percent
revision for XLPE is 2.9% and for non XLPE is 4.4%
(Table KT29 and Figure KT33).

Table KT28 Cumulative Percent Revision of Primary Total Knee Replacement by Polyethylene Type (Primary Diagnosis OA)
N N
Polyethylene Type 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Non XLPE 16332 370987 1.1 (1.0, 1.1) 2.9 (2.9, 3.0) 3.9 (3.8, 4.0) 5.7 (5.6, 5.8) 7.8 (7.6, 8.0) 8.4 (8.1, 8.7)
XLPE 3290 163042 0.9 (0.8, 0.9) 2.1 (2.0, 2.2) 2.7 (2.6, 2.8) 3.7 (3.5, 3.9)
TOTAL 19622 534029
Note: Includes 10,091 procedures using XLPE + Antioxidant

Excludes 173 procedures with unknown bearing surface
Figure KT31 Cumulative Percent Revision of Primary Total Knee Replacement by Polyethylene Type (Primary Diagnosis OA)

24%
Non XLPE
Non XLPE vs XLPE
22% XLPE
0 - 6Mth: HR=1.09 (1.00, 1.18),p=0.052
20% 6Mth - 1Yr: HR=1.40 (1.28, 1.54),p<0.001
1Yr - 1.5Yr: HR=1.65 (1.50, 1.82),p<0.001
18%
1.5Yr - 2Yr: HR=1.56 (1.39, 1.74),p<0.001
16% 2Yr - 2.5Yr: HR=1.40 (1.23, 1.59),p<0.001
14% 2.5Yr+: HR=1.73 (1.60, 1.86),p<0.001
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Non XLPE 370987 342318 283174 223427 86828 7941 1859
XLPE 163042 131797 80012 45078 6475 1 0

a o a .o rg.a u 221
Figure KT32 Cumulative Incidence Revision Diagnosis of Primary Total Knee Replacement by Polyethylene Type (Primary
Diagnosis OA)
Non XLPE XLPE
5.0% 5.0%
Loosening Loosening
Infection Infection
4.0% Pain 4.0% Pain
3.0% 3.0%
2.0% 2.0%
1.0% 1.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Table KT29 Cumulative Percent Revision of Primary Total Knee Replacement by Polyethylene Type and Age (Primary Diagnosis
OA)
N N
Polyethylene Type Age 1 Yr 3 Yrs 5 Yrs 10 Yrs 15 Yrs 16 Yrs
Revised Total
Non XLPE <65 7851 120129 1.4 (1.3, 1.5) 4.1 (3.9, 4.2) 5.5 (5.4, 5.7) 8.4 (8.2, 8.6) 11.9 (11.5, 12.3) 12.8 (12.3, 13.4)
≥65 8481 250858 0.9 (0.9, 1.0) 2.4 (2.3, 2.5) 3.1 (3.1, 3.2) 4.4 (4.3, 4.5) 5.6 (5.4, 5.8) 5.9 (5.6, 6.2)
XLPE <65 1529 55436 1.1 (1.0, 1.2) 2.8 (2.7, 3.0) 3.7 (3.5, 3.9) 5.2 (4.9, 5.6)
≥65 1761 107606 0.8 (0.7, 0.8) 1.7 (1.7, 1.8) 2.2 (2.1, 2.3) 2.9 (2.7, 3.1)
TOTAL 19622 534029
Figure KT33 Cumulative Percent Revision of Primary Total Knee Replacement by Polyethylene Type and Age (Primary
Diagnosis OA)
Non XLPE <65 vs Non XLPE ≥65
20%
Non XLPE <65 0 - 3Mth: HR=1.07 (0.94, 1.20),p=0.301
18% Non XLPE ≥65 3Mth - 9Mth: HR=1.60 (1.46, 1.75),p<0.001
XLPE <65
9Mth - 2Yr: HR=1.83 (1.73, 1.93),p<0.001
XLPE ≥65
16% 2Yr - 3.5Yr: HR=1.85 (1.73, 1.98),p<0.001
3.5Yr - 4Yr: HR=2.21 (1.91, 2.55),p<0.001
14%
4Yr - 6.5Yr: HR=2.01 (1.86, 2.18),p<0.001
12% 6.5Yr+: HR=2.69 (2.49, 2.90),p<0.001

Non XLPE ≥65 vs XLPE ≥65
10% 0 - 3Mth: HR=0.95 (0.83, 1.07),p=0.382
3Mth - 6Mth: HR=1.23 (1.02, 1.48),p=0.027
8%
6Mth - 2Yr: HR=1.54 (1.42, 1.67),p<0.001
6% 2Yr+: HR=1.59 (1.45, 1.74),p<0.001

Non XLPE <65 vs XLPE <65
4% 0 - 9Mth: HR=1.16 (1.07, 1.27),p<0.001
9Mth - 1Yr: HR=1.58 (1.40, 1.78),p<0.001
2%
1Yr - 1.5Yr: HR=1.57 (1.43, 1.72),p<0.001
1.5Yr - 2.5Yr: HR=1.54 (1.41, 1.67),p<0.001
0%
2.5Yr - 3.5Yr: HR=1.59 (1.44, 1.76),p<0.001
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
3.5Yr - 6.5Yr: HR=1.75 (1.61, 1.90),p<0.001
6.5Yr+: HR=2.29 (2.09, 2.51),p<0.001
XLPE <65 vs XLPE ≥65
0 - 3Mth: HR=1.03 (0.90, 1.17),p=0.687
3Mth - 1Yr: HR=1.70 (1.52, 1.90),p<0.001
1Yr - 1.5Yr: HR=1.83 (1.59, 2.10),p<0.001
1.5Yr+: HR=1.88 (1.71, 2.06),p<0.001

Non XLPE <65 120129 110707 91679 73219 29865 3141 758
≥65 250858 231611 191495 150208 56963 4800 1101
XLPE <65 55436 44784 27572 15690 2326 0 0
≥65 107606 87013 52440 29388 4149 1 0

a o a .o rg.a u 223
Table KT30 Cumulative Percent Revision of Primary Total Knee Replacement by Prosthesis Combination and Polyethylene Type
Femoral/Tibial Polyethylene N N
Combination Type Revised Total
Genesis II
Non XLPE 739 19793 3.0 (2.8, 3.3) 3.4 (3.1, 3.7) 4.4 (4.1, 4.7) 4.7 (4.3, 5.0) 5.1 (4.7, 5.6) 5.6 (5.1, 6.1)
CR/Genesis II
XLPE 20 1144 2.6 (1.5, 4.3)
Genesis II
Oxinium Non XLPE 368 6171 3.8 (3.4, 4.3) 4.3 (3.8, 4.9) 5.8 (5.2, 6.5) 6.8 (6.1, 7.6) 8.2 (7.3, 9.2) 8.9 (7.8, 10.2)
CR/Genesis II
XLPE 30 1402 3.9 (2.6, 5.8) 3.9 (2.6, 5.8)
Genesis II
Oxinium Non XLPE 662 11256 4.9 (4.5, 5.3) 5.4 (5.0, 5.9) 6.9 (6.4, 7.4) 7.7 (7.1, 8.4) 8.3 (7.6, 9.1)
PS/Genesis II
XLPE 122 4265 3.9 (3.2, 4.7) 4.9 (3.9, 6.1)
Genesis II
Non XLPE 571 14287 3.3 (3.0, 3.6) 3.7 (3.4, 4.1) 4.7 (4.3, 5.1) 5.2 (4.8, 5.7) 5.6 (5.1, 6.3) 6.2 (5.5, 7.0)
PS/Genesis II
XLPE 60 2166 4.3 (3.2, 5.6) 4.3 (3.2, 5.6)
Legion
Non XLPE 44 1610 3.6 (2.6, 4.9) 3.7 (2.7, 5.1)
CR/Genesis II
XLPE 30 1102 5.0 (3.2, 7.5)
Legion Oxinium
Non XLPE 39 1499 2.8 (2.0, 3.9) 3.1 (2.2, 4.3) 3.4 (2.4, 4.9)
CR/Genesis II
XLPE 20 1158 3.0 (1.9, 4.7) 3.0 (1.9, 4.7)
Legion Oxinium
Non XLPE 173 4776 4.2 (3.6, 4.9) 4.9 (4.2, 5.8) 6.1 (4.9, 7.7)
PS/Genesis II
XLPE 86 5036 3.1 (2.4, 3.9) 3.2 (2.5, 4.1)
Legion
Non XLPE 34 1941 1.8 (1.2, 2.5) 2.0 (1.4, 2.9)
PS/Genesis II
XLPE 37 1906 3.2 (2.3, 4.6) 3.2 (2.3, 4.6)
Natural Knee
Non XLPE 252 2865 2.4 (1.9, 3.1) 3.0 (2.5, 3.8) 4.9 (4.1, 5.8) 7.0 (6.1, 8.1) 9.8 (8.6, 11.2) 12.0 (10.6, 13.6)
II/Natural Knee II
XLPE 105 3576 2.2 (1.8, 2.8) 2.5 (2.1, 3.1) 2.9 (2.4, 3.6) 3.3 (2.7, 4.0) 3.7 (3.0, 4.6) 4.6 (3.0, 6.9)
Nexgen CR
Non XLPE 84 3733 2.1 (1.7, 2.7) 2.4 (1.9, 3.0) 2.7 (2.2, 3.4) 3.2 (2.5, 4.1) 3.2 (2.5, 4.1)
Flex/Nexgen
XLPE 711 38386 2.0 (1.9, 2.2) 2.3 (2.1, 2.4) 2.7 (2.5, 2.9) 3.0 (2.8, 3.3) 3.3 (3.0, 3.7)
Nexgen
Non XLPE 199 5890 1.8 (1.5, 2.2) 2.0 (1.7, 2.4) 2.7 (2.3, 3.2) 3.1 (2.7, 3.7) 3.7 (3.2, 4.3) 4.3 (3.7, 5.0)
CR/Nexgen
XLPE 133 5081 1.9 (1.6, 2.3) 2.1 (1.7, 2.5) 2.6 (2.1, 3.1) 2.9 (2.5, 3.5) 3.2 (2.7, 3.9) 3.6 (3.0, 4.4)
Nexgen LPS
Non XLPE 590 14815 2.7 (2.4, 3.0) 3.1 (2.9, 3.5) 4.4 (4.0, 4.8) 5.1 (4.7, 5.6) 5.9 (5.3, 6.5) 6.1 (5.4, 6.9)
Flex/Nexgen
XLPE 388 15444 2.9 (2.6, 3.3) 3.3 (3.0, 3.7) 4.3 (3.8, 4.8) 4.6 (4.0, 5.2)
PFC Sigma
Non XLPE 575 20412 2.2 (2.0, 2.4) 2.4 (2.2, 2.7) 3.0 (2.8, 3.3) 3.5 (3.2, 3.9) 4.2 (3.8, 4.6) 5.2 (4.5, 5.9)
CR/PFC Sigma
XLPE 24 2223 1.6 (1.1, 2.4) 1.6 (1.1, 2.4)
Scorpio NRG
Non XLPE 18 504 2.4 (1.4, 4.2) 3.1 (1.9, 5.0) 3.1 (1.9, 5.0)
PS/Series 7000
XLPE 124 3322 3.5 (2.9, 4.3) 4.0 (3.3, 4.8) 4.4 (3.7, 5.3)
Triathlon
Non XLPE 253 9618 2.3 (2.0, 2.6) 2.5 (2.2, 2.8) 3.1 (2.7, 3.5) 3.5 (3.1, 4.0)
CR/Triathlon
XLPE 921 50201 2.3 (2.1, 2.4) 2.5 (2.3, 2.7) 3.4 (3.0, 3.7)
Triathlon
Non XLPE 174 3753 4.2 (3.6, 4.9) 4.6 (4.0, 5.4) 5.2 (4.5, 6.1) 5.8 (4.9, 6.8)
PS/Triathlon
XLPE 149 5794 3.1 (2.6, 3.7) 3.5 (3.0, 4.2) 3.7 (3.1, 4.4)
TOTAL 7735 265129

Table KT31 Hazard Ratios of XLPE vs Non XLPE in Primary Total Knee Replacement by Prosthesis Combination (Primary
Diagnosis OA)
Femoral/Tibial Combination Hazard Ratio p-value

Genesis II CR/Genesis II Entire Period 1.00 (0.64, 1.57) 0.994
Genesis II Oxinium CR/Genesis II Entire Period 1.01 (0.69, 1.48) 0.950
Genesis II Oxinium PS/Genesis II Entire Period 0.87 (0.71, 1.06) 0.177
Genesis II PS/Genesis II Entire Period 1.26 (0.96, 1.65) 0.098
Legion CR/Genesis II Entire Period 1.50 (0.93, 2.40) 0.094
Legion Oxinium CR/Genesis II Entire Period 0.96 (0.55, 1.68) 0.894
Legion Oxinium PS/Genesis II Entire Period 0.65 (0.50, 0.84) 0.001
Legion PS/Genesis II Entire Period 1.58 (0.98, 2.56) 0.061
Natural Knee II/Natural Knee II 0-3.5Yr 0.98 (0.70, 1.37) 0.908
3.5Yr – 9 Yr 0.26 (0.17, 0.41) <0.001
9Yr+ 0.11 (0.04, 0.27) <0.001
Nexgen CR Flex/Nexgen Entire Period 0.88 (0.70, 1.11) 0.275
Nexgen CR/Nexgen Entire Period 0.79 (0.63, 0.98) 0.35
Nexgen LPS Flex/Nexgen 0-6Mth 1.37 (1.00, 1.88) 0.050
6Mth – 1.5Yr 0.81 (0.62, 1.06) 0.119
1.5Yr – 2Yr 1.13 (0.75, 1.71) 0.558
2Yr – 2.5Yr 1.51 (0.98, 2.32) 0.059
2.5Yr+ 0.87 (0.70, 1.09) 0.222
PFC Sigma CR/PFC Sigma Entire Period 0.80 (0.53, 1.20) 0.278
Scorpio NRG PS/Series 7000 Entire Period 1.32 (0.78, 2.23) 0.306
Triathlon CR/Triathlon Entire Period 1.02 (0.88, 1.18) 0.796
Triathlon PS/Triathlon Entire Period 0.72 (0.57, 0.90) 0.003

a o a .o rg.a u 225
Table KT32 Cumulative Percent Revision of XLPE Primary Total Knee Replacement by Polyethylene Type (Primary Diagnosis
OA)
N N
Revised Total
XLPE 3202 152951 0.9 (0.9, 1.0) 2.1 (2.0, 2.2) 2.4 (2.4, 2.5) 2.7 (2.6, 2.8) 3.1 (3.0, 3.3) 3.7 (3.5, 3.9)
XLPE + Antioxidant 88 10091 0.6 (0.4, 0.8) 1.8 (1.4, 2.3) 2.8 (1.7, 4.5) 2.8 (1.7, 4.5)
TOTAL 3290 163042
Figure KT34 Cumulative Percent Revision of XLPE Primary Total Knee Replacement by Polyethylene Type (Primary Diagnosis
OA)

24%
XLPE XLPE + Antioxidant vs XLPE
22% XLPE + Antioxidant
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

XLPE 152951 126087 79503 60736 44971 21951 6475
XLPE + Antioxidant 10091 5710 509 161 107 0 0

Figure KT35 Cumulative Percent Revision of XLPE Primary Total Knee Replacement by Polyethylene Type (Primary Diagnosis
OA, Excluding Attune)

24%
XLPE XLPE + Antioxidant vs XLPE
22% XLPE + Antioxidant
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

XLPE 152951 126087 79503 60736 44971 21951 6475
XLPE + Antioxidant 1838 969 279 161 107 0 0

a o a .o rg.a u 227
Shoulder Replacement
Shoulder Replacement
CATEGORIES OF SHOULDER REPLACEMENT
The Registry groups shoulder replacement into reverse shoulder replacement. Definitions for
three broad categories: primary partial, primary each of these are detailed in the subsequent
total and revision shoulder replacement. sections.
A primary replacement is an initial procedure Revision shoulder replacements are re-

undertaken on a joint and involves replacing operations of previous shoulder replacements
either part (partial) or all (total) of the articular where one or more of the prosthetic
surface. components are replaced, removed, or
another component is added. Revision
Primary partial and primary total shoulder procedures include re-operations of primary
replacements are further sub-categorised into partial, primary total, or previous revision
classes depending on the type of prosthesis procedures.
used. Partial shoulder classes include: partial
resurfacing, hemi resurfacing, hemi mid head, Shoulder revision procedures are sub-
hemi stemmed and humeral ball replacement . categorised into three classes: minor, major
Total shoulder classes include: total resurfacing, partial and major total shoulder replacement.
total mid head, total conventional and total
SHOULDER REPLACEMENT
PARTIAL TOTAL
RESURFACING RESURFACING
MINOR
HEMI TOTAL
RESURFACING MID HEAD
MAJOR
PARTIAL
HEMI TOTAL
MID HEAD CONVENTIONAL
MAJOR
TOTAL
HEMI TOTAL
STEMMED REVERSE
HUMERAL BALL

a o a .o rg.a u 229
USE OF SHOULDER REPLACEMENT

This report is an analysis of 38,265 shoulder The proportion of total shoulder replacements
replacement procedures reported to the has increased from 57.6% in 2008 to 84.7% in
Registry with a procedure date up to and 2016. Since 2008, partial shoulder replacement
including 31 December 2016. This is an has decreased from 32.6% to 6.2% in 2016. In
additional 5,859 shoulder procedures since the 2008, the proportion of revision procedures was
last report. 9.8%. This peaked at 10.8% in 2012 and 2015. In
2016, the proportion of revision procedures has
Registry shoulder data collection commenced declined to 9.1%. This equates to 96 less revision
in 2004 and full national collection was procedures in 2016 than would have been
implemented by 2008. expected if the proportion of revision
procedures had remained at the peak of
The number of shoulder replacement 10.8% (Figure S1).
procedures undertaken in 2016 increased by
569 (11.1%) compared to the previous year
and by 115.5% since 2008. The proportion of revision procedures of 9.1%
equates to 96 fewer revision procedures in
2016 than if the proportion of revision
Shoulder replacement procedures procedures had remained at 10.8%.
increased by 11.1% in 2016 and increased
by 115.5% since 2008.
Figure S1 Proportion of Shoulder Replacement by
Shoulder Category
When considering all shoulder replacement 100%
procedures currently recorded by the Registry, Partial
90% Total
primary total shoulder replacement is the most Revision
common category (73.7%), followed by 80%
primary partial (16.2%) and revision procedures
70%
(10.1%) (Table S1).
60%
50%
Table S1 Number of Shoulder Replacements 40%
Shoulder Category Number Percent 30%

Partial 6191 16.2 20%
Total 28193 73.7
10%
Revision 3881 10.1
0%
TOTAL 38265 100.0
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20

ASA SCORE AND BMI

Data is reported on shoulder replacement Overall, in 92.0% of procedures, patients have
procedures for both the American Society of an ASA score of 2 or 3, 5.1% have a score of 1
Anaesthesiologists - Physical Status Classification and 2.9% have a score of 4. In three
(ASA score) and Body Mass Index (BMI). The procedures, patients have a score of 5.
Registry commenced collecting ASA score in
2012 and BMI data in 2015. There is a difference depending on the class of
shoulder replacement. Revision shoulder
There is ASA score data on 17,146 procedures replacement procedures have a higher
and BMI data on 8,153 shoulder replacement proportion of patients with an ASA score of 3
procedures. (53.2%) compared to primary partial shoulder
replacement (43.8%), or total shoulder
In 2016, the ASA score is reported in 97.4% of replacement (45.4%) (Table S1).
procedures and BMI is reported in 80.6% of
shoulder replacement procedures.
BMI
In 2016, the percentage of procedures where BMI for adults is classified by the World Health
the ASA score was reported for primary partial Organisation into six main categories
shoulders is 95.7%, primary total shoulder 97.5% (http://apps.who.int/bmi/index.jsp?introPage=i
and revision shoulder replacement 97.3%. There ntro_3.html):
is some variation in reporting of BMI based on 1. Underweight <18.50
procedure type. BMI is reported for 67.3% of 2. Normal 18.50 - 24.99
primary partial shoulders, 81.8% of primary total 3. Pre-obese 25.00 - 29.99
shoulders and 79.3% of revision shoulder 4. Obese Class 1 30.00 - 34.99
replacements. 5. Obese Class 2 35.00 - 39.99
6. Obese Class 3 ≥40.00
In the future, this data will be used to risk adjust
in a range of analyses. For all shoulder replacements, the majority of
procedures are undertaken in patients who are
pre-obese or obese class 1 (61.3%). There is a
ASA SCORE
higher proportion of primary total shoulder
There are five ASA score classifications replacement procedures where the patients
(https://www.asahq.org/resources/clinical- are pre-obese or obese class 1 (61.8%),
information/asa-physical-status-classification- compared to partial shoulder replacement
system): (59.2%), and revision shoulder replacement
1. A normal healthy patient. (58.1%) (Table S2).
2. A patient with mild systemic disease.
3. A patient with severe systemic disease. There is a gender difference, with a higher
4. A patient with severe systemic disease proportion of females in obese categories for all
that is a constant threat to life. procedure groups (Figure S2).
5. A moribund patient who is not
expected to survive without the
operation.

a o a .o rg.a u 231
Table S2 ASA Score by Shoulder Category

1 133 9.4 669 4.8 68 3.9 870 5.1
2 608 42.8 6592 47.1 675 39.1 7875 45.9
3 622 43.8 6355 45.4 919 53.2 7896 46.1
4 57 4.0 379 2.7 66 3.8 502 2.9
5 . . 3 0.0 . . 3 0.0
TOTAL 1420 100.0 13998 100.0 1728 100.0 17146 100.0
Table S3 BMI Category for Shoulder Replacement by Shoulder Category

Underweight 6 1.3 58 0.8 10 1.3 74 0.9
Normal 89 18.8 1144 16.6 152 19.2 1385 17.0
Pre-obese 163 34.5 2331 33.8 254 32.2 2748 33.7
Obese Class 1 117 24.7 1932 28.0 205 25.9 2254 27.6
Obese Class 2 61 12.9 907 13.2 106 13.4 1074 13.2
Obese Class 3 37 7.8 518 7.5 63 8.0 618 7.6
TOTAL 473 100.0 6890 100.0 790 100.0 8153 100.0
Note: BMI has not been presented for patients aged 19 years or less
Figure S2 BMI Distribution by Gender and Shoulder Category
Note: BMI has not been presented for patients aged 19 years or less

Primary Partial Shoulder Replacement

CLASSES OF PARTIAL SHOULDER
REPLACEMENT
The Registry sub-categorises primary partial Table SP1 Primary Partial Shoulder Replacement by Class
shoulder replacement into four main classes.
These are defined by the type of prosthesis Shoulder Class Number Percent
used. Partial Resurfacing 159 2.6
Hemi Resurfacing 1405 22.7
Partial resurfacing involves the use of one or Hemi Stemmed 4594 74.2
more button prostheses to replace part of the Hemi Mid Head 33 0.5
natural articulating surface, on one or both
TOTAL 6191 100.0
sides of the shoulder joint.
Hemi resurfacing involves the use of a humeral
prosthesis that replaces the humeral articular
The use of the two main classes of partial
surface only, without resecting the head.
shoulder replacement has declined over recent
Hemi mid head involves resection of part of the
years. The number of hemi resurfacing
humeral head and replacement with a cone
procedures decreased from 178 in 2012 to 107
stemmed humeral head prosthesis.
in 2016. The number of hemi stemmed
Hemi stemmed involves the resection of the
procedures decreased from 523 in 2012 to 231
humeral head and replacement with a
in 2016 (Figure SP1).
stemmed humeral prosthesis and humeral head
prosthesis.
There is a fifth class of partial shoulder Figure SP1 Primary Partial Shoulder Replacement by Class
replacement reported to the Registry. This is a 800
Partial Resurfacing Hemi Resurfacing
spherical non-stemmed humeral head Hemi Stemmed Hemi Mid Head
700
prosthesis referred to as the Humeral Ball. It is
used following partial resection of the humeral 600
head. Only two procedures using this device
500
have been reported to the Registry. Both of
these procedures have now been revised. 400
USE OF PARTIAL SHOULDER 300
REPLACEMENT 200
There have been 6,191 primary partial shoulder 100

replacements reported to the Registry up to 31
0
December 2016. This is an additional 379
08
09
10
11
12
13
14
15
16
procedures compared to the number reported

20
20
20
20
20
20
20
20
20
last year.
The most common class of primary partial Primary partial shoulder replacement is more
shoulder replacement is hemi stemmed. This common in females (65.0%). However, there is
accounts for 74.2% of all partial shoulder gender variation depending on the class of
replacements, followed by hemi resurfacing primary partial shoulder replacement. The
(22.7%), partial resurfacing (2.6%) and hemi mid proportions of primary partial shoulder
head (0.5%) (Table SP1). replacement for females are: hemi stemmed
(73.3%), hemi mid head (54.5%), hemi
resurfacing (43.3%) and partial resurfacing
(21.4%) (Table SP2).
Most patients are aged 65 years or older

(65.6%). The proportion of patients in this age
group varies depending on the class of primary

a o a .o rg.a u 233
partial shoulder replacement: hemi stemmed hemi mid head have only been used in small
(71.3%), hemi resurfacing (52.4%), hemi mid numbers (159 and 33, respectively). This makes
head (48.5%) and partial resurfacing (21.4%) any assessment of comparative performance
(Table SP3). difficult. However, there is a clear difference in
the two more commonly used classes. These
Overall, males undergoing a partial shoulder devices have longer follow up and the
replacement are younger (mean age 62.2 cumulative percent revision at nine years for
years compared to 71.7 years for females) hemi resurfacing is greater than for hemi
(Table SP4). stemmed replacement (15.1% compared to
10.5%) (Table SP6 and Figure SP2).
The most common primary diagnoses are
fracture (45.8%) and osteoarthritis (39.9%) (Table When the diagnosis of osteoarthritis is
SP5). considered, hemi resurfacing has a higher rate
of revision compared to hemi stemmed after
The five year cumulative percent revision varies 2.5 years (Table SP7 and Figure SP3).
depending on class. Partial resurfacing and
Table SP2 Primary Partial Shoulder Replacement by Gender and Class
Male Female
Shoulder Class N Row% N Row%
Partial Resurfacing 125 78.6 34 21.4
Hemi Resurfacing 796 56.7 609 43.3
Hemi Stemmed 1228 26.7 3366 73.3
Hemi Mid Head 15 45.5 18 54.5
TOTAL 2164 35.0 4027 65.0
Table SP3 Primary Partial Shoulder Replacement by Age and Class
<55 55-64 65-74 ≥75

Shoulder Class N Row% N Row% N Row% N Row%
Partial Resurfacing 111 69.8 14 8.8 18 11.3 16 10.1
Hemi Resurfacing 281 20.0 387 27.5 436 31.0 301 21.4
Hemi Stemmed 432 9.4 886 19.3 1388 30.2 1888 41.1
Hemi Mid Head 9 27.3 8 24.2 11 33.3 5 15.2
TOTAL 833 13.5 1295 20.9 1853 29.9 2210 35.7
Table SP4 Primary Partial Shoulder Replacement by Age and Gender

Male 2164 35.0% 14 93 64 62.2 14.5
Female 4027 65.0% 13 101 73 71.7 11.2
TOTAL 6191 100.0% 13 101 70 68.4 13.2

Table SP5 Primary Partial Shoulder Replacement by Primary Diagnosis and Gender
Male Female TOTAL

Primary Diagnosis N Col% N Col% N Col%
Fracture 615 28.4 2222 55.2 2837 45.8
Osteoarthritis 1165 53.8 1304 32.4 2469 39.9
Rotator Cuff Arthropathy 114 5.3 176 4.4 290 4.7
Osteonecrosis 72 3.3 107 2.7 179 2.9
Instability 98 4.5 56 1.4 154 2.5
Tumour 70 3.2 56 1.4 126 2.0
Rheumatoid Arthritis 18 0.8 91 2.3 109 1.8
Other Inflammatory Arthritis 10 0.5 15 0.4 25 0.4
Osteochondritis Dissecans 2 0.1 . . 2 0.0
TOTAL 2164 100.0 4027 100.0 6191 100.0
Note: Instability includes instability, dislocation and Hills-Sachs Defect
Table SP6 Cumulative Percent Revision of Primary Partial Shoulder Replacement by Class (All Diagnoses)
N N
Shoulder Category 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Revised Total
Partial Resurfacing 6 159 0.6 (0.1, 4.5) 1.3 (0.3, 5.2) 1.3 (0.3, 5.2) 5.5 (2.2, 13.8)
Hemi Resurfacing 152 1405 1.5 (1.0, 2.3) 7.7 (6.3, 9.3) 11.1 (9.4, 13.1) 13.9 (11.9, 16.2) 15.1 (12.8, 17.7)
Hemi Stemmed 364 4594 2.9 (2.4, 3.4) 7.6 (6.8, 8.4) 9.0 (8.1, 10.0) 9.7 (8.7, 10.7) 10.5 (9.3, 11.8)
Hemi Mid Head 5 33 3.8 (0.6, 24.3) 24.0 (10.6, 48.9) 24.0 (10.6, 48.9)
TOTAL 527 6191
Figure SP2 Cumulative Percent Revision of Primary Partial Shoulder Replacement by Class (All Diagnoses)
30%
Hemi Resurfacing
Hemi Resurfacing vs Hemi Stemmed
Hemi Stemmed
0 - 1Yr: HR=0.48 (0.30, 0.77),p=0.002
25% 1Yr - 1.5Yr: HR=1.16 (0.75, 1.80),p=0.509
1.5Yr - 2Yr: HR=0.75 (0.41, 1.39),p=0.368
2Yr+: HR=2.04 (1.54, 2.70),p<0.001
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Hemi Resurfacing 1405 1271 1044 715 418 105 17
Hemi Stemmed 4594 4059 3031 1986 1012 204 23

a o a .o rg.a u 235
Table SP7 Cumulative Percent Revision of Primary Partial Shoulder Replacement by Class (Primary Diagnosis OA)
N N
Shoulder Class 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Revised Total
Hemi Resurfacing 125 1225 1.4 (0.8, 2.2) 7.0 (5.6, 8.7) 10.4 (8.7, 12.5) 13.3 (11.2, 15.8) 14.6 (12.2, 17.5)
Hemi Stemmed 91 1161 2.5 (1.7, 3.6) 6.5 (5.2, 8.2) 8.4 (6.8, 10.4) 9.7 (7.9, 11.9) 10.4 (8.4, 12.9)
TOTAL 216 2386
Figure SP3 Cumulative Percent Revision of Primary Partial Shoulder Replacement by Class (Primary Diagnosis OA)
30%
Hemi Resurfacing
Hemi Resurfacing vs Hemi Stemmed
Hemi Stemmed
0 - 2.5Yr: HR=0.80 (0.56, 1.14),p=0.220
25% 2.5Yr+: HR=2.04 (1.27, 3.26),p=0.003
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Hemi Resurfacing 1225 1106 909 616 365 97 14
Hemi Stemmed 1161 1049 806 582 321 74 6

PRIMARY PARTIAL RESURFACING SHOULDER REPLACEMENT

DEMOGRAPHICS AND OUTCOMES
There have been 159 primary partial resurfacing The most common primary diagnosis is instability
shoulder replacement procedures reported to (48.4%), followed by osteoarthritis (39.6%) (Table
the Registry. This is an additional 10 procedures SP9).
compared to the previous report.
The cumulative percent revision at seven years
This procedure is undertaken more commonly in is 5.5% (Table SP6). Of the six revisions, four were
males (78.6%). The mean age for males is 40.2 for glenoid erosion and two were for
years compared to 60.1 years for females instability/dislocation. All were revised to a total
(Table SP8). conventional shoulder replacement.
Table SP8 Primary Partial Resurfacing Shoulder Replacement by Age and Gender

Male 125 78.6% 14 87 37 40.2 18.0
Female 34 21.4% 17 88 64 60.1 18.5
TOTAL 159 100.0% 14 88 43 44.5 19.8
Table SP9 Primary Partial Resurfacing Shoulder Replacement by Primary Diagnosis and Gender
Male Female TOTAL

Instability 65 52.0 12 35.3 77 48.4
Osteoarthritis 45 36.0 18 52.9 63 39.6
Fracture 8 6.4 2 5.9 10 6.3
Osteonecrosis 2 1.6 2 5.9 4 2.5
Osteochondritis Dissecans 2 1.6 . . 2 1.3
Rotator Cuff Arthropathy 2 1.6 . . 2 1.3
Tumour 1 0.8 . . 1 0.6
TOTAL 125 100.0 34 100.0 159 100.0
Note: Instability includes instability, dislocation and Hill-Sachs Defect

a o a .o rg.a u 237
PRIMARY HEMI RESURFACING SHOULDER REPLACEMENT

DEMOGRAPHICS
There have been 1,405 primary hemi Osteoarthritis is the most common primary
resurfacing shoulder replacements reported to diagnosis (87.2%). The range of diagnoses is
the Registry. This is an additional 113 procedures similar for males and females (Table SP11).
compared to the previous report. The use of
primary hemi resurfacing has declined by 50.7% The three most used prostheses in 2016 were the
since 2008. PyroTITAN, Copeland and Global CAP (Table
SP12).
This procedure is more common in males
(56.7%). The mean age is 61.3 years for males
and 68.5 years for females (Table SP10).
Table SP10 Primary Hemi Resurfacing Shoulder Replacement by Age and Gender

Male 796 56.7% 19 90 62 61.3 12.0
Female 609 43.3% 27 93 70 68.5 11.2
TOTAL 1405 100.0% 19 93 65 64.4 12.2
Table SP11 Primary Hemi Resurfacing Shoulder Replacement by Primary Diagnosis and Gender
Male Female TOTAL

Osteoarthritis 698 87.7 527 86.5 1225 87.2
Osteonecrosis 16 2.0 17 2.8 33 2.3
Instability 13 1.6 5 0.8 18 1.3
Fracture 10 1.3 4 0.7 14 1.0
TOTAL 796 100.0 609 100.0 1405 100.0
Note: Instability includes instability and dislocation
Table SP12 Most Used Humeral Head Prostheses in Primary Hemi Resurfacing Shoulder Replacement
2008 2013 2014 2015 2016

124 Copeland 35 Copeland 31 Copeland 26 Copeland 81 PyroTITAN
45 Global CAP 33 PyroTITAN 19 Global CAP 21 PyroTITAN 14 Copeland
34 SMR 19 Global CAP 9 SMR 16 Global CAP 8 Global CAP
11 Aequalis 14 Aequalis 4 Aequalis 6 SMR 4 SMR
Custom Made
2 Epoca RH 14 SMR 1 4 Aequalis
(Copeland)
1 Buechel-Pappas 1 Epoca RH
Most Used
217 (6) 100.0% 115 (5) 100.0% 65 (6) 100.0% 73 (5) 100.0% 107 (4) 100.0%

OUTCOME FOR ALL DIAGNOSES OUTCOME FOR OSTEOARTHRITIS

Reason for Revision Age and Gender
The main reasons for revision of hemi Patients aged 75 years or older have a lower
resurfacing shoulder replacement are glenoid rate of revision after 3.5 years compared to
erosion (25.7%), pain (23.7%), rotator cuff patients aged less than 55 years (Table SP15
insufficiency (13.8%) and loosening (11.2%) and Figure SP5).
(Table SP13 and Figure SP4). There were three
reported humeral head breakages. All of them Gender is not a risk factor for revision (Table
were reported in the PyroTITAN prosthesis. In SP16 and Figure SP6).
addition, a further three breakages of this
prosthesis were associated with loosening. The outcomes of the most commonly used
prostheses are listed in Table SP17.
Type of Revision
The most common type of revision is to a total
shoulder replacement (90.1%). Of these, 72
(52.6%) were revised to a total reverse shoulder Glenoid erosion or pain are the reasons for
and 65 (47.5%) to a total conventional shoulder 49% of all hemi resurfacing shoulder
replacement (Table SP14). revisions.

a o a .o rg.a u 239
Table SP13 Primary Hemi Resurfacing Shoulder Table SP14 Primary Hemi Resurfacing Shoulder
Replacement by Reason for Revision Replacement by Type of Revision

Glenoid Erosion 39 25.7 Humeral/Glenoid 137 90.1
Pain 36 23.7 Glenoid Component 6 3.9
Rotator Cuff Insufficiency 21 13.8 Humeral Component 6 3.9
Loosening 17 11.2 Removal of Prostheses 1 0.7
Instability/Dislocation 16 10.5 Reoperation 1 0.7
Infection 4 2.6 TOTAL 152 100.0
Implant Breakage Head 3 2.0
Malposition 2 1.3
Incorrect Sizing 2 1.3
Fracture 2 1.3
Metal Related Pathology 2 1.3
Arthrofibrosis 1 0.7
Osteonecrosis 1 0.7
Implant Breakage Humeral 1 0.7
TOTAL 152 100.0
Figure SP4 Cumulative Incidence Revision DiagnosisHemi Resurfacing

of Primary Hemi Resurfacing Shoulder Replacement (All Diagnoses)
5.0%
Glenoid Erosion
Pain
Rotator Cuff Insufficiency
4.0% Loosening
Instability/Dislocation
3.0%
2.0%
1.0%
0.0%
0 1 2 3 4 5 6 7 8 9 10

Table SP15 Cumulative Percent Revision of Primary Hemi Resurfacing Shoulder Replacement by Age (Primary Diagnosis OA)
N N
Revised Total
<55 26 231 0.5 (0.1, 3.3) 5.3 (2.9, 9.7) 10.3 (6.6, 15.9) 17.6 (11.9, 25.5)
55-64 49 341 2.4 (1.2, 4.8) 10.3 (7.4, 14.4) 14.9 (11.2, 19.6) 18.5 (14.1, 24.1)
65-74 32 390 0.8 (0.3, 2.5) 5.8 (3.8, 8.9) 8.2 (5.7, 11.8) 9.8 (6.9, 13.9)
≥75 18 263 1.6 (0.6, 4.2) 5.8 (3.5, 9.7) 7.9 (5.0, 12.3) 7.9 (5.0, 12.3)
TOTAL 125 1225
Figure SP5 Cumulative Percent Revision of Primary Hemi Resurfacing Shoulder Replacement by Age (Primary Diagnosis OA)
24%
<55
55-64 vs <55
22% 55-64
65-74 0 - 2.5Yr: HR=1.35 (0.73, 2.49),p=0.345
20% ≥75 2.5Yr+: HR=1.04 (0.57, 1.89),p=0.897
18% 65-74 vs <55

14% ≥75 vs <55

0 - 1.5Yr: HR=0.83 (0.34, 2.03),p=0.682
12%
1.5Yr - 3.5Yr: HR=0.47 (0.19, 1.14),p=0.093
10% 3.5Yr+: HR=0.24 (0.07, 0.82),p=0.023
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10

<55 231 196 167 115 59 21 3
55-64 341 304 246 165 103 26 6
65-74 390 359 300 203 123 37 4
≥75 263 247 196 133 80 13 1

a o a .o rg.a u 241
Table SP16 Cumulative Percent Revision of Primary Hemi Resurfacing Shoulder Replacement by Gender (Primary Diagnosis
OA)
N N
Revised Total
Male 65 698 1.7 (0.9, 3.0) 6.0 (4.3, 8.2) 9.3 (7.1, 12.1) 12.6 (9.9, 16.2) 14.6 (11.2, 18.8)
Female 60 527 1.0 (0.4, 2.3) 8.3 (6.1, 11.2) 11.8 (9.1, 15.2) 14.2 (11.1, 18.1) 14.8 (11.5, 18.9)
TOTAL 125 1225
Figure SP6 Cumulative Percent Revision of Primary Hemi Resurfacing Shoulder Replacement by Gender (Primary Diagnosis
OA)
24%
Male
Female vs Male
22% Female
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10

Male 698 613 513 331 198 55 8
Female 527 493 396 285 167 42 6
Table SP17 Cumulative Percent Revision of Primary Hemi Resurfacing Shoulder Replacement by Humeral Head (Primary
Diagnosis OA)
N N
Humeral Head 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Revised Total
Aequalis 10 78 1.3 (0.2, 8.9) 9.4 (4.6, 18.7) 11.1 (5.7, 21.1) 19.4 (9.8, 36.2)
Copeland 50 531 1.5 (0.8, 3.0) 5.9 (4.1, 8.3) 9.1 (6.9, 12.2) 10.7 (8.1, 14.0) 11.7 (8.9, 15.4)
Global CAP 25 205 0.5 (0.1, 3.5) 8.8 (5.5, 14.0) 12.1 (8.1, 18.1) 13.8 (9.3, 20.1)
PyroTITAN 12 242 2.4 (1.0, 5.8) 5.8 (3.1, 10.6)
SMR 23 146 0.0 (0.0, 0.0) 6.7 (3.5, 12.5) 13.8 (8.8, 21.3) 22.1 (14.9, 32.0)
Other (3) 5 23 4.3 (0.6, 27.1) 17.4 (6.9, 39.9) 17.4 (6.9, 39.9) 23.3 (10.3, 47.7) 23.3 (10.3, 47.7)
TOTAL 125 1225
Note: Only prostheses with over 50 procedures have been listed

PRIMARY HEMI MID HEAD SHOULDER REPLACEMENT

DEMOGRAPHICS AND OUTCOME
There have been 33 primary hemi mid head There have been an additional two revisions
shoulder replacement procedures reported to reported in 2016. Of the five revisions reported
the Registry. This is an additional nine overall, there was one for each of the following
procedures compared to the previous report. reasons: fracture, pain, loosening, rotator cuff
insufficiency and glenoid erosion (Table SP20).
This procedure is undertaken more commonly in
females (54.5%). The mean age is 65.3 years for The most common type of revision is to a total
females and 59.1 years for males (Table SP18). shoulder replacement (Table SP21).
Osteoarthritis is the most common primary The most common humeral head and stem
diagnosis (60.6%) (Table SP19). prosthesis combinations are the Affinis (11), the
Eclipse (10) and the Affiniti (7).
Table SP18 Primary Hemi Mid Head Shoulder Replacement by Age and Gender

Male 15 45.5% 44 83 59 59.1 12.1
Female 18 54.5% 30 85 66 65.3 12.8
TOTAL 33 100.0% 30 85 64 62.5 12.7
Table SP19 Primary Hemi Mid Head Shoulder Replacement by Primary Diagnosis and Gender
Male Female TOTAL

Osteoarthritis 9 60.0 11 61.1 20 60.6
Osteonecrosis 4 26.7 4 22.2 8 24.2
Fracture . . 2 11.1 2 6.1
Rotator Cuff Arthropathy 2 13.3 . . 2 6.1
Rheumatoid Arthritis . . 1 5.6 1 3.0
TOTAL 15 100.0 18 100.0 33 100.0
Table SP20 Primary Hemi Mid Head Shoulder Table SP21 Primary Hemi Mid Head Shoulder

Fracture 1 20.0 Humeral/Glenoid 3 60.0
Pain 1 20.0 Humeral Component 1 20.0
Loosening 1 20.0 Glenoid Component 1 20.0
Rotator Cuff Insufficiency 1 20.0 TOTAL 5 100.0
Glenoid Erosion 1 20.0
TOTAL 5 100.0

a o a .o rg.a u 243
PRIMARY HEMI STEMMED SHOULDER REPLACEMENT

DEMOGRAPHICS
There have been 4,594 primary hemi stemmed The most common humeral head prostheses
shoulder replacement procedures reported to used in 2016 were the Aequalis, Global Unite
the Registry. This is an additional 249 procedures and SMR. The 10 most used humeral head
compared to the previous report. prostheses accounted for 86.1% of all primary
hemi stemmed procedures in 2016. This has
This procedure is more common in females decreased from 98.2% in 2008 (Table SP24).
(73.3%). The mean age is 72.4 years for females
and 65.1 years for males (Table SP22). The most common humeral stem prostheses
used in 2016 were the SMR, Global Unite and
The most common primary diagnosis is fracture Aequalis Ascend. The 10 most used stem
(61.2%), followed by osteoarthritis (25.3%) (Table prostheses accounted for 92.2% of all primary
SP23). In 2016, the number of primary hemi hemi stemmed procedures in 2016. This has
stemmed shoulder replacements undertaken decreased from 97.2% in 2008 (Table SP25).
for fracture decreased by 70.4% compared to
2008. In 2016, the number of primary hemi
stemmed shoulder replacements undertaken There has been a major decline in the use of
for osteoarthritis decreased by 64.6% compared primary hemi stemmed shoulder
to 2008 (Figure SP7). replacement for the management of
osteoarthritis and fracture.
Table SP22 Primary Hemi Stemmed Shoulder Replacement by Age and Gender

Male 1228 26.7% 14 93 66 65.1 13.5
Female 3366 73.3% 13 101 74 72.4 10.9
TOTAL 4594 100.0% 13 101 72 70.4 12.1
Table SP23 Primary Hemi Stemmed Shoulder Replacement by Primary Diagnosis and Gender
Male Female TOTAL

Fracture 597 48.6 2214 65.8 2811 61.2
Osteoarthritis 413 33.6 748 22.2 1161 25.3
Osteonecrosis 50 4.1 84 2.5 134 2.9
Tumour 69 5.6 56 1.7 125 2.7
Instability 20 1.6 39 1.2 59 1.3
TOTAL 1228 100.0 3366 100.0 4594 100.0

Figure SP7 Primary Hemi Stemmed Shoulder Replacement by Primary Diagnosis
500
Fracture
Osteoarthritis
Other
400
300
200
100
0
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
Table SP24 10 Most Used Humeral Head Prostheses in Primary Hemi Stemmed Shoulder Replacement
2008 2013 2014 2015 2016

197 Global Advantage 109 SMR 83 SMR 47 SMR 40 Aequalis
177 SMR 71 Global Advantage 73 Aequalis 44 Aequalis 35 Global Unite
98 Aequalis 64 Aequalis 47 Global Advantage 38 Global Unite 31 SMR
38 Bigliani/Flatow 37 Global Unite 31 Global AP 31 Global Advantage 20 Global AP
31 SMR CTA 33 Bigliani/Flatow 29 Bigliani/Flatow 28 Bigliani/Flatow 15 Comprehensive
Global Advantage
22 26 Global AP 25 Global Unite 26 Global AP 14 Bigliani/Flatow
CTA
15 Bio-Modular 19 SMR CTA 20 SMR CTA 10 SMR CTA 12 SMR CTA
13 Solar 16 Global AP CTA 9 Global AP CTA 9 Bio-Modular 11 Bio-Modular
8 Global AP 14 Comprehensive 7 Bio-Modular 7 Ascend 11 Global Advantage
6 Univers 3D 12 Bio-Modular 6 Delta Xtend 7 Global AP CTA 10 Global Advantage CTA
10 Most Used
605 (10) 98.2% 401 (10) 89.7% 330 (10) 91.4% 247 (10) 86.7% 199 (10) 86.1%
Remainder
11 (4) 1.8% 46 (14) 10.3% 31 (10) 8.6% 38 (11) 13.3% 32 (8) 13.9%
TOTAL
616 (14) 100.0% 447 (24) 100.0% 361 (20) 100.0% 285 (21) 100.0% 231 (18) 100.0%

a o a .o rg.a u 245
Table SP25 10 Most Used Humeral Stem Prostheses in Primary Hemi Stemmed Shoulder Replacement
2008 2013 2014 2015 2016

207 SMR 128 SMR 104 SMR 58 SMR 43 SMR
138 Global FX 66 Global FX 49 Aequalis 38 Global Unite 35 Global Unite
98 Aequalis 64 Aequalis 44 Global FX 33 Global AP 27 Aequalis Ascend
81 Global Advantage 42 Global AP 40 Global AP 31 Aequalis Ascend 26 Comprehensive
26 Bigliani/Flatow TM 37 Global Unite 29 Aequalis Ascend 30 Global FX 25 Global AP
13 Solar 27 Bigliani/Flatow TM 26 Bigliani/Flatow TM 21 Bigliani/Flatow TM 17 Aequalis
11 Bigliani/Flatow 26 Comprehensive 25 Global Unite 18 Aequalis 12 Global Advantage
11 Bio-Modular 15 Global Advantage 11 Comprehensive 14 Comprehensive 11 Bigliani/Flatow TM
8 Global AP 7 Delta Xtend 7 Global Advantage 5 Delta Xtend 9 Global FX
6 Univers 3D 4 Ascend 6 Delta Xtend 5 Equinoxe 8 Mutars
10 Most Used
599 (10) 97.2% 416 (10) 93.1% 341 (10) 94.5% 253 (10) 88.8% 213 (10) 92.2%
Remainder
17 (7) 2.8% 31 (13) 6.9% 20 (8) 5.5% 32 (10) 11.2% 18 (7) 7.8%
TOTAL
616 (17) 100.0% 447 (23) 100.0% 361 (18) 100.0% 285 (20) 100.0% 231 (17) 100.0%

Primary Diagnosis Type of Revision
There is no difference in the rate of revision The most common type of revision is to a total
when primary hemi stemmed shoulder shoulder replacement for both primary
replacement is performed for fracture or diagnoses (71.7% for osteoarthritis and 54.9% for
osteoarthritis (Table SP26 and Figure SP8). fracture). Most were revised to a total reverse
shoulder replacement (97.1% when used for
fracture and 84.0% for osteoarthritis). Glenoid
There is no difference in the rate of revision component only revision occurs more
when primary hemi stemmed shoulder commonly in procedures undertaken for
replacement is performed for fracture or osteoarthritis (28.6% compared to 4.6% for
osteoarthritis. fracture) (Table SP28).
Reason for Revision

Reasons for revision vary depending on primary
diagnosis. Rotator cuff insufficiency occurs
more frequently in hemi stemmed shoulder
replacement undertaken for fracture (27.0%),
whereas glenoid erosion occurs more
frequently in procedures undertaken for
osteoarthritis (28.6%) (Table SP27 and Figure
SP9).

Table SP26 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Primary Diagnosis
N N
Revised Total
Fracture 237 2811 3.0 (2.5, 3.8) 8.3 (7.3, 9.5) 9.7 (8.5, 11.0) 10.0 (8.8, 11.3) 10.4 (9.1, 11.8)
Osteoarthritis 91 1161 2.5 (1.7, 3.6) 6.5 (5.2, 8.2) 8.4 (6.8, 10.4) 9.7 (7.9, 11.9) 10.4 (8.4, 12.9)
Rotator Cuff Arthropathy 12 203 2.1 (0.8, 5.5) 5.8 (3.2, 10.6) 7.4 (4.2, 12.9)
Osteonecrosis 7 134 1.6 (0.4, 6.2) 4.1 (1.7, 9.7) 5.3 (2.4, 11.6)
Tumour 9 125 5.3 (2.2, 12.3)
Other (4) 8 160 2.6 (1.0, 6.8) 4.6 (2.2, 9.5) 4.6 (2.2, 9.5) 4.6 (2.2, 9.5)
TOTAL 364 4594
Figure SP8 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Primary Diagnosis
30%
Fracture
Fracture vs Osteoarthritis
Osteoarthritis
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Fracture 2811 2505 1871 1159 582 103 10
Osteoarthritis 1161 1049 806 582 321 74 6

a o a .o rg.a u 247
Table SP27 Primary Hemi Stemmed Shoulder Replacement by Reason for Revision and Primary Diagnosis
Fracture Osteoarthritis
Reason for Revision Number % Revisions Number % Revisions
Revised Revised
Rotator Cuff Insufficiency 64 2.3 27.0 13 1.1 14.3
Instability/Dislocation 46 1.6 19.4 17 1.5 18.7
Glenoid Erosion 11 0.4 4.6 26 2.2 28.6
Pain 25 0.9 10.5 11 0.9 12.1
Fracture 22 0.8 9.3 4 0.3 4.4
Loosening 21 0.7 8.9 9 0.8 9.9
Infection 20 0.7 8.4 4 0.3 4.4
Arthrofibrosis 7 0.2 3.0 2 0.2 2.2
Malposition 7 0.2 3.0 1 0.1 1.1
Dissociation 3 0.1 1.3 1 0.1 1.1
Lysis 2 0.1 0.8
Heterotopic Bone 1 0.0 0.4
Incorrect Sizing 1 0.0 0.4 1 0.1 1.1
Osteonecrosis 1 0.1 1.1
Other 7 0.2 3.0 1 0.1 1.1
N Revision 237 8.4 100.0 91 7.8 100.0
N Primary 2811 1161
Figure SP9 Cumulative Incidence Revision Diagnosis of Primary Hemi Stemmed Shoulder by Primary Diagnosis
5.0% 5.0%
Rotator Cuff Insufficiency Rotator Cuff Insufficiency
Instability/Dislocation Instability/Dislocation
Glenoid Erosion Glenoid Erosion
4.0% Pain 4.0% Pain
Loosening Loosening
3.0% 3.0%
2.0% 2.0%
1.0% 1.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10

Table SP28 Primary Hemi Stemmed Shoulder Replacement by Type of Revision and Primary Diagnosis
Type of Revision Number % Revisions Number % Revisions
Revised Revised
Humeral/Glenoid 170 6.0 71.7 50 4.3 54.9
Glenoid Component 11 0.4 4.6 26 2.2 28.6
Humeral Component 24 0.9 10.1 6 0.5 6.6
Head Only 14 0.5 5.9 3 0.3 3.3
Cement Spacer 7 0.2 3.0 1 0.1 1.1
Removal of Prostheses 5 0.2 2.1 1 0.1 1.1
Cement Only 4 0.1 1.7
Reoperation 2 0.1 0.8 2 0.2 2.2
Head/Insert 1 0.1 1.1
Minor Components 1 0.1 1.1
N Revision 237 8.4 100.0 91 7.8 100.0
N Primary 2811 1161

a o a .o rg.a u 249
OUTCOME FOR FRACTURE

Age and Gender
The rate of revision is lower for those aged 75
years or older compared to all other age Cemented stem fixation for fracture has a
groups (Table SP29 and Figure SP10). lower rate of revision when a non-fracture
stem is used.
Females have a higher rate of revision
compared to males (Table SP30 and Figure
SP11).
The outcomes for the most used prosthesis
combinations in the treatment of fracture are
Humeral Stem
listed in Table SP33. The outcomes for individual
There is no difference in the rate of revision for fracture stems are presented separately in
fracture humeral stems compared to non Table SP34 and non fracture humeral stems in
fracture humeral stems (Table SP31 and Figure Table SP35.
SP12).
The use of cement for stem fixation in fracture

hemiarthroplasty has a lower rate of revision
when a non-fracture stem is used (Table SP32
and Figure SP13).

Table SP29 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Age (Primary Diagnosis
Fracture)
N N
Revised Total
<55 25 214 2.4 (1.0, 5.8) 9.7 (6.2, 15.0) 15.6 (10.7, 22.5) 15.6 (10.7, 22.5)
55-64 68 549 5.9 (4.2, 8.3) 12.5 (9.9, 15.8) 13.3 (10.6, 16.7) 14.1 (11.2, 17.6)
65-74 94 825 4.0 (2.8, 5.6) 10.9 (8.9, 13.4) 12.6 (10.4, 15.4) 13.2 (10.8, 16.0)
≥75 50 1223 1.2 (0.7, 2.0) 4.4 (3.3, 5.8) 4.9 (3.7, 6.4) 4.9 (3.7, 6.4) 4.9 (3.7, 6.4)
TOTAL 237 2811
Figure SP10 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Age (Primary Diagnosis
Fracture)
30%
<55
<55 vs ≥75
55-64
65-74 0 - 1.5Yr: HR=2.51 (1.28, 4.94),p=0.007
25% ≥75 1.5Yr+: HR=4.39 (2.35, 8.21),p<0.001
55-64 vs ≥75
65-74 vs ≥75
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

<55 214 186 139 76 44 10 0
55-64 549 479 363 248 134 16 0
65-74 825 738 552 348 177 37 7
≥75 1223 1102 817 487 227 40 3

a o a .o rg.a u 251
Table SP30 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Gender (Primary Diagnosis
Fracture)
N N
Revised Total
Male 46 597 3.5 (2.3, 5.4) 7.5 (5.5, 10.1) 9.2 (6.9, 12.2) 9.6 (7.2, 12.8)
Female 191 2214 2.9 (2.3, 3.7) 8.5 (7.4, 9.9) 9.8 (8.5, 11.2) 10.1 (8.8, 11.6) 10.6 (9.1, 12.2)
TOTAL 237 2811
Figure SP11 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Gender (Primary Diagnosis
Fracture)
30%
Male
Female vs Male
Female
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Male 597 509 381 225 119 19 1
Female 2214 1996 1490 934 463 84 9

Table SP31 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Stem Type (Primary Diagnosis
Fracture)
N N
Fracture 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Revised Total
Fracture Humeral Stem 103 1369 2.4 (1.7, 3.4) 7.4 (6.0, 9.0) 8.8 (7.2, 10.6) 9.3 (7.7, 11.3) 9.3 (7.7, 11.3)
Non-Fracture Humeral Stem 134 1442 3.6 (2.7, 4.7) 9.2 (7.8, 11.0) 10.5 (8.9, 12.4) 10.7 (9.0, 12.6) 11.4 (9.5, 13.5)
TOTAL 237 2811
Figure SP12 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Stem Type (Primary Diagnosis
Fracture)
30%
Fracture Humeral Stem
Non-Fracture Humeral Stem vs
Non-Fracture Humeral Stem
Fracture Humeral Stem
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Fracture Humeral Stem 1369 1222 901 546 278 59 4
Non-Fracture Humeral Stem 1442 1283 970 613 304 44 6

a o a .o rg.a u 253
Table SP32 Yearly Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Stem Type and Humeral
Fixation (Primary Diagnosis Fracture)
Humeral N N
Fracture 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Fixation Revised Total
Fracture
Cementless 10 101 5.2 (2.2, 12.0) 12.4 (6.7, 22.2)
Humeral Stem
Cemented 93 1268 2.2 (1.5, 3.2) 7.0 (5.7, 8.7) 8.5 (6.9, 10.4) 9.0 (7.4, 11.0) 9.0 (7.4, 11.0)
Non-Fracture
Cementless 88 761 4.2 (3.0, 5.9) 11.3 (9.2, 13.9) 12.7 (10.4, 15.5) 13.0 (10.6, 15.8)
Humeral Stem
Cemented 46 681 3.0 (1.9, 4.6) 6.8 (5.1, 9.2) 8.0 (6.0, 10.6) 8.0 (6.0, 10.6)
TOTAL 237 2811
Figure SP13 Cumulative Percent Revisionof Primary Hemi Stemmed Shoulder Replacement by Stem Type and Humeral Fixation
(Primary Diagnosis Fracture)
30%
Fracture Humeral Stem Cementless Fracture Humeral Stem Cementless vs
Fracture Humeral Stem Cemented
Fracture Humeral Stem Cemented
Non-Fracture Humeral Stem Cementless
25% Non-Fracture Humeral Stem Cemented Entire Period: HR=1.31 (0.68, 2.53),p=0.419
Fracture Humeral Stem Cemented vs

Non-Fracture Humeral Stem Cemented

20%
Fracture Humeral Stem Cementless vs

15%
Non-Fracture Humeral Stem Cementless
10% Non-Fracture Humeral Stem Cementless vs

Non-Fracture Humeral Stem Cemented
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Fracture
Cementless 101 86 45 14 3 1 0
Humeral Stem
Cemented 1268 1136 856 532 275 58 4
Non-Fracture
Cementless 761 679 505 326 165 19 3
Humeral Stem
Cemented 681 604 465 287 139 25 3

Table SP33 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Humeral Head and Stem
N N
Humeral Head Humeral Stem 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Revised Total
Aequalis Aequalis 28 429 2.6 (1.5, 4.7) 6.5 (4.5, 9.5) 7.2 (5.0, 10.3) 7.2 (5.0, 10.3)
Bigliani/Flatow Bigliani/Flatow TM 8 284 1.5 (0.6, 3.9) 3.1 (1.6, 6.1) 3.1 (1.6, 6.1) 3.1 (1.6, 6.1)
Bio-Modular Comprehensive 3 70 1.6 (0.2, 10.7) 3.5 (0.9, 13.3) 7.1 (2.1, 21.9) 7.1 (2.1, 21.9)
Comprehensive Comprehensive 0 34 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Global Advantage Global Advantage 9 53 7.7 (2.9, 19.1) 15.9 (8.3, 29.3) 18.2 (9.9, 32.1) 18.2 (9.9, 32.1)
Global Advantage Global FX 49 685 2.1 (1.3, 3.5) 6.2 (4.6, 8.5) 7.8 (5.9, 10.4) 8.7 (6.6, 11.4) 8.7 (6.6, 11.4)
Global Unite Global Unite 19 129 5.2 (2.4, 11.2)
SMR SMR 97 858 4.0 (2.8, 5.5) 10.9 (8.9, 13.3) 12.6 (10.4, 15.3) 12.9 (10.6, 15.6)
SMR CTA SMR 2 33 3.3 (0.5, 21.4) 7.4 (1.9, 26.5) 7.4 (1.9, 26.5) 7.4 (1.9, 26.5)
Solar Solar 5 40 7.9 (2.6, 22.5) 10.5 (4.1, 25.7) 14.3 (6.1, 31.3) 14.3 (6.1, 31.3)
Other (24) 17 196 2.8 (1.2, 6.7) 10.1 (6.3, 16.0) 11.0 (6.9, 17.2) 11.0 (6.9, 17.2)
TOTAL 237 2811
Table SP34 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Humeral Head and Fracture
Stem (Primary Diagnosis Fracture)
N N
Humeral Head Fracture Stem 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Revised Total
Bio-Modular Comprehensive 3 70 1.6 (0.2, 10.7) 3.5 (0.9, 13.3) 7.1 (2.1, 21.9) 7.1 (2.1, 21.9)
Global Advantage Global FX 49 685 2.1 (1.3, 3.5) 6.2 (4.6, 8.5) 7.8 (5.9, 10.4) 8.7 (6.6, 11.4) 8.7 (6.6, 11.4)
Global Unite Global Unite 19 128 5.2 (2.4, 11.2)
Other (5) 5 44 2.6 (0.4, 17.2) 10.7 (4.2, 26.2) 16.7 (6.8, 37.9) 16.7 (6.8, 37.9)
TOTAL 103 1369
Table SP35 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Humeral Head and Non
Fracture Stem (Primary Diagnosis Fracture)
N N
Humeral Head Non Fracture Stem 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Revised Total
Bigliani/Flatow Bigliani/Flatow TM 8 284 1.5 (0.6, 3.9) 3.1 (1.6, 6.1) 3.1 (1.6, 6.1) 3.1 (1.6, 6.1)
Global Advantage Global Advantage 9 53 7.7 (2.9, 19.1) 15.9 (8.3, 29.3) 18.2 (9.9, 32.1) 18.2 (9.9, 32.1)
SMR SMR 97 858 4.0 (2.8, 5.5) 10.9 (8.9, 13.3) 12.6 (10.4, 15.3) 12.9 (10.6, 15.6)
SMR CTA SMR 2 33 3.3 (0.5, 21.4) 7.4 (1.9, 26.5) 7.4 (1.9, 26.5) 7.4 (1.9, 26.5)
Solar Solar 5 40 7.9 (2.6, 22.5) 10.5 (4.1, 25.7) 14.3 (6.1, 31.3) 14.3 (6.1, 31.3)
Other (25) 13 174 3.2 (1.3, 7.5) 9.1 (5.4, 15.3) 9.1 (5.4, 15.3) 9.1 (5.4, 15.3)
TOTAL 134 1442

a o a .o rg.a u 255

Age and Gender
The rate of revision is lower for those aged 75 The outcomes of the most used prosthesis
years or older compared to patients aged less combinations for osteoarthritis are listed in Table
than 55 years and 55 to 64 years (Table SP36 SP38.
and Figure SP14).
Gender is not a risk factor for revision (Table

SP37 and Figure SP15).
Table SP36 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Age (Primary Diagnosis OA)
N N
Revised Total
<55 12 88 4.9 (1.9, 12.6) 10.9 (5.6, 20.9) 12.7 (6.7, 23.2) 14.9 (8.2, 26.4)
55-64 26 223 3.8 (1.9, 7.4) 10.1 (6.6, 15.2) 13.4 (9.2, 19.3) 14.3 (9.9, 20.4)
65-74 26 374 1.7 (0.7, 3.7) 5.2 (3.3, 8.2) 7.1 (4.8, 10.6) 9.2 (6.2, 13.5)
≥75 27 476 2.2 (1.2, 4.0) 5.1 (3.4, 7.7) 6.4 (4.4, 9.4) 6.9 (4.7, 10.0)
TOTAL 91 1161
Figure SP14 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Age (Primary Diagnosis OA)
30%
<55
<55 vs ≥75
55-64
65-74 Entire Period: HR=2.75 (1.36, 5.55),p=0.004
25% ≥75
55-64 vs ≥75
20%
65-74 vs ≥75
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

<55 88 76 51 41 28 7 0
55-64 223 197 156 113 59 12 2
65-74 374 347 270 193 116 24 1
≥75 476 429 329 235 118 31 3

Table SP37 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Gender (Primary Diagnosis OA)
N N
Revised Total
Male 33 413 3.3 (1.9, 5.6) 7.0 (4.8, 10.1) 8.1 (5.7, 11.5) 9.7 (6.7, 13.9)
Female 58 748 2.1 (1.3, 3.5) 6.3 (4.7, 8.4) 8.6 (6.6, 11.1) 9.7 (7.5, 12.5) 9.7 (7.5, 12.5)
TOTAL 91 1161
Figure SP15 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Gender (Primary Diagnosis OA)
30%
Male
Male vs Female
Female
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Male 413 373 280 193 105 20 3
Female 748 676 526 389 216 54 3

a o a .o rg.a u 257
Table SP38 Cumulative Percent Revision of Primary Hemi Stemmed Shoulder Replacement by Humeral Head and Stem
Prostheses (Primary Diagnosis OA)
N N
Humeral Head Humeral Stem 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Revised Total
Aequalis
Aequalis 1 53 2.4 (0.3, 15.7)
Ascend
Bigliani/Flatow
Bigliani/Flatow 3 52 3.9 (1.0, 14.8) 5.9 (1.9, 17.3) 5.9 (1.9, 17.3) 5.9 (1.9, 17.3)
TM
Delta Xtend Delta Xtend 1 26 0.0 (0.0, 0.0) 5.0 (0.7, 30.5) 5.0 (0.7, 30.5) 5.0 (0.7, 30.5)
Global AP Global AP 7 155 0.7 (0.1, 4.8) 3.8 (1.6, 9.0) 6.4 (3.0, 13.3)
Global AP CTA Global AP 5 40 2.5 (0.4, 16.5) 13.2 (5.7, 28.9) 13.2 (5.7, 28.9)
Global Global
11 144 0.7 (0.1, 4.8) 5.1 (2.4, 10.3) 7.4 (4.1, 13.4) 8.3 (4.7, 14.6)
Advantage Advantage
Global
Global FX 4 31 3.3 (0.5, 21.4) 10.8 (3.6, 30.1) 10.8 (3.6, 30.1) 10.8 (3.6, 30.1)
Advantage
Global Global
1 39 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 4.0 (0.6, 25.2) 4.0 (0.6, 25.2)
Advantage CTA Advantage
SMR SMR 34 269 4.2 (2.4, 7.5) 8.6 (5.7, 12.7) 12.2 (8.7, 17.0) 14.1 (10.2, 19.4)
SMR CTA SMR 6 85 4.9 (1.8, 12.4) 7.7 (3.5, 16.3) 7.7 (3.5, 16.3) 7.7 (3.5, 16.3)
Other (25) 9 129 3.3 (1.2, 8.5) 7.2 (3.7, 14.0) 8.7 (4.5, 16.2)
TOTAL 91 1161

Primary Total Shoulder Replacement

CLASSES OF TOTAL SHOULDER REPLACEMENT
The Registry sub-categorises primary total Primary total shoulder replacement is more
shoulder replacement into four classes. These common in females (62.1%). However, there is
are defined by the type of prosthesis used. gender variation depending on the class of
primary total shoulder replacement. The
Total resurfacing involves glenoid replacement proportions of primary total shoulder
and the use of a humeral prosthesis that replacement for females are: total reverse
replaces the humeral articular surface without (65.6%), total conventional (58.1%), total mid
resecting the head. head (55.1%), and total resurfacing (39.3%)
Total mid head involves glenoid replacement (Table ST2).
combined with resection of part of the humeral
head and replacement with a cone stemmed
humeral head prosthesis. Figure ST1 Proportion of Primary Total Shoulder
Total conventional involves glenoid Replacement by Class
replacement combined with resection of the
100%
humeral head and replacement with a Total Resurfacing Total Conventional
90% Total Reverse Total Mid Head
stemmed humeral prosthesis and humeral head
prosthesis. 80%
Total reverse involves glenoid replacement with
70%
a glenoid head prosthesis combined with
resection of the humeral head and 60%
replacement with a stemmed humeral 50%

prosthesis and humeral cup prosthesis.
40%
USE OF TOTAL SHOULDER REPLACEMENT 30%
There have been 28,193 total shoulder 20%
replacements reported to the Registry. This is an 10%

additional 4,941 procedures compared to the
0%
previous report.
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
The two main classes of primary total shoulder
replacement are total conventional (40.7%) and
total reverse (56.0%). Total mid head and total Most patients are aged 65 years or older
resurfacing shoulder replacement are used (82.2%). The proportion of patients in this age
infrequently (2.6% and 0.7%, respectively) (Table group varies depending on the class of shoulder
ST1). The proportion of total reverse shoulder replacement: total reverse (90.3%), total
replacements has increased from 42.2% in 2009 conventional (72.5%), total mid head (66.5%)
to 69.3% in 2016 (Figure ST1). and total resurfacing (51.7%) (Table ST3).
Table ST1 Primary Total Shoulder Replacement by Class The mean age for total shoulder replacement is
73.5 years for females and 70.1 years for males
Shoulder Class N Percent (Table ST4).
Total Resurfacing 211 0.7
Total Conventional 11468 40.7 The most common primary diagnoses are
Total Reverse 15781 56.0 osteoarthritis (67.0%), rotator cuff arthropathy
Total Mid Head 733 2.6 (19.2%) and fracture (8.8%). Rheumatoid arthritis
TOTAL 28193 100.0
and osteonecrosis account for 2.0% and 1.3%,
respectively (Table ST5).

a o a .o rg.a u 259
Only 211 total resurfacing shoulder An additional analysis has been undertaken
replacements have been reported to the with both the SMR L2 total conventional and the
Registry, 15 of which have been revised. The SMR L2 total reverse shoulder prostheses
cumulative percent revision at five years is 6.9% excluded. These prostheses have been
(Table ST6). withdrawn.
Total mid head shoulder replacement has been After excluding the SMR L2 prosthesis from both
used in 733 procedures. There have been 11 total conventional and reverse shoulder
revisions and the three year cumulative percent procedures, the nine year cumulative percent
revision is 2.1% (Table ST6). revision for total conventional and total reverse
shoulder replacement is 8.6% and 6.9%,
At nine years, the cumulative percent revision respectively. The total reverse shoulder
for total conventional and total reverse shoulder replacement continues to have a higher rate of
replacement is 11.3% and 7.0%, respectively. revision in the first three months. After this time,
Total reverse shoulder replacement has a higher total conventional shoulder replacement has a
rate of revision compared to total conventional higher rate of revision (Table ST7 and Figure ST3).
in the first three months. However, after three
months, total reverse shoulder replacement has
a lower rate of revision (Table ST6 and Figure
ST2).
Table ST2 Primary Total Shoulder Replacement by Gender and Class
Male Female
Shoulder Class N Row% N Row%
Total Resurfacing 128 60.7 83 39.3
Total Conventional 4806 41.9 6662 58.1
Total Reverse 5434 34.4 10347 65.6
Total Mid Head 329 44.9 404 55.1
TOTAL 10697 37.9 17496 62.1
Table ST3 Primary Total Shoulder Replacement by Age and Class
<55 55-64 65-74 ≥75

Shoulder Class N Row% N Row% N Row% N Row%
Total Resurfacing 31 14.7 71 33.6 93 44.1 16 7.6
Total Conventional 587 5.1 2565 22.4 5017 43.7 3299 28.8
Total Reverse 213 1.3 1311 8.3 5748 36.4 8509 53.9
Total Mid Head 57 7.8 189 25.8 326 44.5 161 22.0
TOTAL 888 3.1 4136 14.7 11184 39.7 11985 42.5
Table ST4 Primary Total Shoulder Replacement by Age and Gender

Male 10697 37.9% 21 96 71 70.1 9.1
Female 17496 62.1% 14 102 74 73.5 8.5
TOTAL 28193 100.0% 14 102 73 72.2 8.9

Table ST5 Primary Total Shoulder Replacement by Primary Diagnosis and Gender
Male Female TOTAL

Osteoarthritis 7670 71.7 11213 64.1 18883 67.0
Fracture 383 3.6 2095 12.0 2478 8.8
Osteonecrosis 78 0.7 286 1.6 364 1.3
Instability 85 0.8 143 0.8 228 0.8
Tumour 56 0.5 59 0.3 115 0.4
Other 7 0.1 7 0.0 14 0.0
TOTAL 10697 100.0 17496 100.0 28193 100.0

a o a .o rg.a u 261
Table ST6 Cumulative Percent Revision of Primary Total Shoulder Replacement by Class (All Prostheses)
N N
Revised Total
Total Resurfacing 15 211 2.0 (0.7, 5.1) 4.7 (2.5, 8.9) 6.9 (3.9, 11.9)
Total Reverse 582 15781 2.7 (2.5, 3.0) 3.9 (3.5, 4.2) 4.7 (4.3, 5.1) 5.3 (4.8, 5.8) 7.0 (6.0, 8.2)
Total Mid Head 11 733 1.6 (0.8, 3.1) 2.1 (1.2, 3.8)
TOTAL 1410 28193
Figure ST2 Cumulative Percent Revision of Primary Total Shoulder Replacement by Class (All Prostheses)
30%
Total Conventional
Total Conventional vs Total Reverse
Total Reverse
0 - 3Mth: HR=0.32 (0.24, 0.41),p<0.001
25% 3Mth+: HR=2.16 (1.88, 2.47),p<0.001
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Total Reverse 15781 11856 6643 3268 1295 227 38

Table ST7 Cumulative Percent Revision of Primary Total Shoulder Replacement by Class (excluding SMR L2)
N N
Revised Total
Total Reverse 521 14641 2.7 (2.4, 3.0) 3.8 (3.5, 4.2) 4.6 (4.2, 5.0) 5.2 (4.6, 5.7) 6.9 (5.8, 8.1)
TOTAL 1058 25251
Note: The SMR L2 total reverse shoulder prosthesis and the SMR L2 total conventional shoulder prosthesis have both been excluded
Figure ST3 Cumulative Percent Revision of Primary Total Shoulder Replacement by Class (excluding SMR L2)
30%
Total Conventional
Total Conventional vs Total Reverse
Total Reverse
0 - 3Mth: HR=0.29 (0.22, 0.39),p<0.001
25% 3Mth+: HR=1.55 (1.33, 1.81),p<0.001
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Total Reverse 14641 10781 5640 2571 1271 227 38
Note: The SMR L2 total reverse shoulder prosthesis and the SMR L2 total conventional shoulder prosthesis have both been excluded

a o a .o rg.a u 263
PRIMARY TOTAL RESURFACING SHOULDER REPLACEMENT

There have been 211 primary total resurfacing There were three different types of total
shoulder replacements reported to the Registry. resurfacing prosthesis combinations used in
This is an additional 13 procedures compared 2016. The Global CAP/Global Advantage
to the previous report. combination was used in nine of the 11
procedures reported in 2016 (Tables ST10 and
Primary total resurfacing shoulder replacement ST11).
is undertaken more often in males (60.7%). The
mean age is 62.1 years for males and 66.5 years The cumulative percent revision at five years is
for females (Table ST8). 6.9% (Table ST6). There have been 15 revisions.
The main reasons for revision are presented in
Osteoarthritis is the most common primary Table ST12. The most common type of revision is
diagnosis (95.7%) (Table ST9). to a total shoulder replacement (40.0%) (Table
ST13).
Table ST8 Primary Total Resurfacing Shoulder Replacement by Age and Gender

Male 128 60.7% 35 83 63 62.1 9.7
Female 83 39.3% 46 86 67 66.5 6.8
TOTAL 211 100.0% 35 86 65 63.8 8.9
Table ST9 Primary Total Resurfacing Shoulder Replacement by Primary Diagnosis and Gender
Male Female TOTAL

Osteoarthritis 124 96.9 78 94.0 202 95.7
Fracture 1 0.8 1 1.2 2 0.9
Other Inflammatory Arthritis . . 1 1.2 1 0.5
Instability 1 0.8 . . 1 0.5
Rotator Cuff Arthropathy . . 1 1.2 1 0.5
Osteonecrosis 1 0.8 . . 1 0.5
TOTAL 128 100.0 83 100.0 211 100.0

Table ST10 Most Used Humeral Head Prostheses in Primary Total Resurfacing Shoulder Replacement
2008 2013 2014 2015 2016

5 SMR 27 Global CAP 17 Global CAP 12 Global CAP 9 Global CAP
4 Aequalis 5 Aequalis 6 Aequalis 4 Epoca RH 1 Epoca RH
2 Copeland 3 Epoca RH 1 Epoca RH 2 Aequalis 1 SMR
1 Global CAP 1 SMR 1 SMR
Most Used
12 (4) 100.0% 36 (4) 100.0% 24 (3) 100.0% 19 (4) 100.0% 11 (3) 100.0%
Table ST11 Most Used Glenoid Prostheses in Primary Total Resurfacing Shoulder Replacement
2008 2013 2014 2015 2016

4 Aequalis 27 Global Advantage 17 Global Advantage 12 Global Advantage 9 Global Advantage
3 SMR L1 5 Aequalis 6 Aequalis 4 Epoca 1 Epoca
2 Copeland 3 Epoca 1 Epoca 2 Aequalis 1 SMR
2 SMR 1 SMR L1 1 SMR
1 Global Advantage
Most Used
12 (5) 100.0% 36 (4) 100.0% 24 (3) 100.0% 19 (4) 100.0% 11 (3) 100.0%
Table ST12 Primary Total Resurfacing Shoulder Table ST13 Primary Total Resurfacing Shoulder

Loosening 5 33.3 Humeral/Glenoid 6 40.0
Instability/Dislocation 2 13.3 Humeral Component 5 33.3
Infection 2 13.3 Insert Only 2 13.3
Implant Breakage Glenoid Cement Spacer 1 6.7
2 13.3
Insert Head Only 1 6.7
Wear Glenoid Insert 1 6.7 TOTAL 15 100.0
Fracture 1 6.7
Implant Breakage Glenoid 1 6.7 Note: Humeral heads are replaced when the humeral component
Rotator Cuff Insufficiency 1 6.7 is revised
TOTAL 15 100.0

a o a .o rg.a u 265
PRIMARY TOTAL MID HEAD SHOULDER REPLACEMENT

There have been 733 primary total mid head The cumulative percent revision at three years is
shoulder replacements reported to the Registry. 2.1% (Table ST6). There have been 11 revisions in
This is an additional 271 procedures compared this class. The main reasons for revision are
to the previous report. The use of primary mid instability/dislocation, loosening, and infection
head shoulder replacement has increased by (Table ST16). The most common types of revision
273.2% since its first full year of use in 2012. involve replacement of the humeral
component only and replacement of the
Primary total mid head shoulder replacement is humeral component and glenoid. The latter
undertaken more often in females (55.1%). The were all revised to a total reverse shoulder
mean age is 69.8 years for females and 65.3 replacement (Table ST17).
years for males (Table ST14).
The Affinis is the most used total mid head
Osteoarthritis is the most common primary shoulder prosthesis in 2016 (Tables ST18 and
diagnosis (95.8%) (Table ST15). ST19).
Table ST14 Primary Total Mid Head Shoulder Replacement by Age and Gender

Male 329 44.9% 37 89 66 65.3 9.4
Female 404 55.1% 45 94 70 69.8 8.0
TOTAL 733 100.0% 37 94 68 67.8 8.9
Table ST15 Primary Total Mid Head Shoulder Replacement by Primary Diagnosis and Gender
Male Female TOTAL

Osteoarthritis 317 96.4 385 95.3 702 95.8
Osteonecrosis 5 1.5 9 2.2 14 1.9
Other Inflammatory Arthritis . . 4 1.0 4 0.5
Fracture 1 0.3 2 0.5 3 0.4
Instability 2 0.6 . . 2 0.3
Other 1 0.3 . . 1 0.1
TOTAL 329 100.0 404 100.0 733 100.0

Table ST16 Primary Total Mid Head Shoulder Table ST17 Primary Total Mid Head Shoulder

Loosening 3 27.3 Humeral/Glenoid 3 27.3
Pain 1 9.1 Head Only 1 9.1
Malposition 1 9.1 Cement Spacer 1 9.1
TOTAL 11 100.0 Cup Only 1 9.1
TOTAL 11 100.0
Table ST18 Most Used Humeral Stem Prostheses in Primary Total Mid Head Shoulder Replacement
2011 2013 2014 2015 2016

2 Simpliciti 60 Affinis 61 Simpliciti 108 Affinis 217 Affinis
2 TESS 36 Simpliciti 52 Affinis 45 Sidus 18 Simpliciti
1 Affinis 3 Sidus 12 Sidus 11 Simpliciti 12 Sidus
3 SMR 10 SMR
8 Comprehensive
Most Used
5 (3) 100.0% 99 (3) 100.0% 125 (3) 100.0% 167 (4) 100.0% 265 (5) 100.0%
Table ST19 Most Used Glenoid Prostheses in Primary Total Mid Head Shoulder Replacement
2011 2013 2014 2015 2016

2 Aequalis 60 Affinis 61 Aequalis 108 Affinis 215 Affinis
1 Affinis 36 Aequalis 52 Affinis 18 Anatomical Shoulder 18 Aequalis
1 Comprehensive 2 Bigliani/Flatow TM 7 Bigliani/Flatow TM 15 Bigliani/Flatow 12 Comprehensive
1 TESS 1 Bigliani/Flatow 3 Bigliani/Flatow 11 Aequalis 6 SMR L1
2 Anatomical Shoulder 11 Bigliani/Flatow TM 4 SMR
3 SMR L1 3 Bigliani/Flatow
1 Global 2 Anatomical Shoulder
2 Bigliani/Flatow TM
2 Global
1 Custom Made (Lima)
Most Used
5 (4) 100.0% 99 (4) 100.0% 125 (5) 100.0% 167 (7) 100.0% 265 (10) 100.0%
Data Period 1 September 1999 31 December 2016 Page | 267

a o a .o rg.a u 267
PRIMARY TOTAL CONVENTIONAL SHOULDER REPLACEMENT

DEMOGRAPHICS
There have been 11,468 total conventional Figure ST5 Proportion of Primary Total Conventional
Shoulder Replacement by Age
shoulder replacements reported to the Registry.
This is an additional 1,238 procedures 100%
<55 55-64
compared to the previous report. 65-74 ≥75
90%
The use of total conventional shoulder 80%
replacement has declined from 55.9% of all 70%

total shoulder replacements in 2008 to 24.9% in
60%
2016.
50%
40%
The use of total conventional shoulder 30%
replacement has declined from 55.9% of all 20%

total shoulder replacements in 2008 to 24.9%
10%
in 2016.
0%
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
This procedure is most commonly undertaken in
females (58.1%) (Table ST20). The proportion of
males has increased slightly from 38.7% in 2008
The mean age is 70.7 years for females and 67.2
to 45.1% in 2016 (Figure ST4).
years for males (Table ST20). In 2016, most
procedures were undertaken in the 65 to 74
year age group, which accounted for 46.2% of
Figure ST4 Proportion of Primary Total Conventional all patients (Figure ST5).
Shoulder Replacement by Gender
100% Osteoarthritis is the most common primary
Male
90% Female diagnosis, accounting for 94.2% of all
procedures (Table ST21).
80%
70%
60%
50%
40%
30%
20%
10%
0%
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
Table ST20 Primary Total Conventional Shoulder Replacement by Age and Gender

Male 4806 41.9% 21 93 67 67.2 9.0
Female 6662 58.1% 21 96 71 70.7 8.5
TOTAL 11468 100.0% 21 96 70 69.2 8.9

In 2016, 72.1% of procedures used hybrid The 10 most used humeral stem and glenoid
fixation (cementless humerus and cemented prostheses are listed in Tables ST22 and ST23. The
glenoid). This has increased from a low of 55.8% Global Unite, SMR, and Global AP are the most
in 2010. In 2016, cementless fiaxtion was used in commonly used humeral stem prostheses in
23.2% of procedures, declining from a peak of 2016. The 10 most used humeral stem prostheses
33.7% in 2011 (Figure ST6). accounted for 97.7% of all primary total
conventional shoulder procedures.
Hybrid fixation with a cemented glenoid has The Global Advantage, Aequalis, and SMR L1
increased from 55.8% in 2010 to 72.1% in are the most commonly used glenoid
2016. prostheses in 2016. The 10 most used glenoid
prostheses account for 98.4% of all primary total
conventional shoulder procedures.
Figure ST6 Proportion of Primary Total Conventional

Shoulder Replacement by Fixation
100%
Cemented
90% Cementless
Hybrid (Glenoid Cemented)
80% Hybrid (Glenoid Cementless)
70%
60%
50%
40%
30%
20%
10%
0%
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
Table ST21 Primary Total Conventional Shoulder Replacement by Primary Diagnosis and Gender
Male Female TOTAL

Osteoarthritis 4603 95.8 6202 93.1 10805 94.2
Osteonecrosis 41 0.9 129 1.9 170 1.5
Fracture 26 0.5 82 1.2 108 0.9
Instability 20 0.4 14 0.2 34 0.3
Tumour 4 0.1 6 0.1 10 0.1
Other 4 0.1 3 0.0 7 0.1
TOTAL 4806 100.0 6662 100.0 11468 100.0
Note: Instability includes dislocation

a o a .o rg.a u 269
Table ST22 10 Most Used Humeral Stem Prostheses in Primary Total Conventional Shoulder Replacement
2008 2013 2014 2015 2016

298 SMR 373 Global AP 388 Global AP 275 SMR 233 Global Unite
167 Aequalis 334 SMR 292 SMR 258 Global AP 228 SMR
117 Global Advantage 192 Aequalis 146 Aequalis Ascend 202 Global Unite 185 Global AP
91 Global AP 120 Bigliani/Flatow TM 145 Aequalis 119 Bigliani/Flatow TM 109 Bigliani/Flatow TM
40 Bigliani/Flatow 103 Ascend 132 Bigliani/Flatow TM 104 Aequalis 91 Comprehensive
37 Bigliani/Flatow TM 51 Global Advantage 77 Global Advantage 81 Ascend 88 Aequalis
32 Solar 26 Equinoxe 44 Comprehensive 72 Comprehensive 84 Aequalis Ascend
27 Affinis 21 Comprehensive 32 Equinoxe 68 Aequalis Ascend 67 Ascend
11 Univers 3D 13 Solar 26 Turon 50 Global Advantage 45 Global Advantage
10 Cofield 2 7 Epoca 22 Ascend 45 Equinoxe 41 Equinoxe
10 Most Used
830 (10) 97.9% 1240 (10) 98.3% 1304 (10) 97.5% 1274 (10) 97.0% 1171 (10) 97.7%
Remainder
18 (7) 2.1% 22 (8) 1.7% 34 (9) 2.5% 40 (4) 3.0% 28 (8) 2.3%
TOTAL
848 (17) 100.0% 1262 (18) 100.0% 1338 (19) 100.0% 1314 (14) 100.0% 1199 (18) 100.0%
Table ST23 10 Most Used Glenoid Prostheses in Primary Total Conventional Shoulder Replacement
2008 2013 2014 2015 2016

237 SMR L1 367 Global Advantage 397 Global Advantage 458 Global Advantage 421 Global Advantage
167 Aequalis 301 SMR L1 311 Aequalis 253 Aequalis 236 Aequalis
157 Global 295 Aequalis 256 SMR L1 239 SMR L1 194 SMR L1
79 Bigliani/Flatow 81 Bigliani/Flatow TM 94 Bigliani/Flatow TM 85 Bigliani/Flatow TM 92 Comprehensive
57 SMR 61 Global 81 Global 73 Comprehensive 84 Bigliani/Flatow TM
52 Global Advantage 40 Bigliani/Flatow 44 Bigliani/Flatow 53 Global 44 Global
32 Solar 33 SMR 44 Comprehensive 45 Equinoxe 41 Equinoxe
27 Affinis 26 Equinoxe 32 Equinoxe 36 Bigliani/Flatow 32 SMR
11 Univers 3D 20 Comprehensive 31 SMR 30 SMR 26 Bigliani/Flatow
10 Cofield 2 13 Solar 26 Turon 24 Turon 10 Turon
10 Most Used
829 (10) 97.8% 1237 (10) 98.0% 1316 (10) 98.4% 1296 (10) 98.6% 1180 (10) 98.4%
Remainder
19 (7) 2.2% 25 (7) 2.0% 22 (7) 1.6% 18 (3) 1.4% 19 (8) 1.6%
TOTAL
848 (17) 100.0% 1262 (17) 100.0% 1338 (17) 100.0% 1314 (13) 100.0% 1199 (18) 100.0%


The cumulative percent revision of primary total The most common type of revision is of the
conventional shoulder replacement for humeral component only (55.4%). This may
osteoarthritis is 12.7% at 10 years. There is no include the revision of a humeral component
difference in the rate of revision when (epiphysis and/or humeral stem) and additional
osteoarthritis is compared to fracture and minor components, such as the humeral head
osteonecrosis. Rheumatoid arthritis has a lower and/or removal of the glenoid component
rate of revision compared to osteoarthritis (Table ST26). Of the 444 humeral component
(Table ST24 and Figure ST7). revisions, 384 (86.5%) were revised to a total
reverse shoulder replacement. The humeral
Reason for Revision
stem was not revised in 367 (82.7%) procedures.
Instability/dislocation is the most common
reason for revision of primary total conventional
shoulder replacement. This accounts for 24.2%
of all revisions, followed by rotator cuff
insufficiency (22.6%), and loosening (16.5%)
(Table ST25). The cumulative incidence of the
five most common reasons for revision are
presented in Figure ST8.

a o a .o rg.a u 271
Table ST24 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Primary Diagnosis
N N
Revised Total
Osteoarthritis 745 10805 2.9 (2.6, 3.3) 6.1 (5.6, 6.6) 8.0 (7.4, 8.6) 9.6 (8.8, 10.3) 11.3 (10.2, 12.5) 12.7 (11.0, 14.5)
Rheumatoid Arthritis 10 212 2.0 (0.7, 5.2) 3.1 (1.4, 6.7) 5.0 (2.6, 9.5) 6.0 (3.2, 11.0)
Osteonecrosis 16 170 4.3 (2.1, 8.8) 8.7 (5.1, 14.5) 10.9 (6.6, 17.7)
Fracture 11 108 5.9 (2.7, 12.7) 9.0 (4.8, 16.7) 10.6 (5.8, 18.9)
Other Inflammatory Arthritis 5 67 1.5 (0.2, 10.4) 3.4 (0.9, 13.1) 9.4 (3.4, 24.3) 9.4 (3.4, 24.3)
Rotator Cuff Arthropathy 9 55 7.6 (2.9, 19.1) 17.0 (8.8, 31.3) 19.5 (10.6, 34.4) 19.5 (10.6, 34.4)
Other (4) 6 51 6.4 (2.1, 18.5) 16.4 (7.5, 33.8) 16.4 (7.5, 33.8)
TOTAL 802 11468
Figure ST7 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Primary Diagnosis
30%
Fracture
Osteoarthritis
Osteonecrosis Entire Period: HR=1.39 (0.76, 2.52),p=0.282
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Fracture 108 94 67 42 17 3 1
Osteoarthritis 10805 9301 6455 3985 1884 378 62
Osteonecrosis 170 145 94 59 34 6 1

Table ST25 Primary Total Conventional Shoulder Table ST26 Primary Total Conventional Shoulder

Rotator Cuff Insufficiency 181 22.6 Humeral/Glenoid 141 17.6
Loosening 132 16.5 Head Only 83 10.3
Implant Breakage Glenoid Insert 88 11.0 Glenoid Component 59 7.4
Infection 50 6.2 Head/Insert 31 3.9
Dissociation 29 3.6 Cement Spacer 24 3.0
Fracture 20 2.5 Removal of Prostheses 11 1.4
Incorrect Sizing 16 2.0 Minor Components 5 0.6
Pain 15 1.9 Reoperation 3 0.4
Arthrofibrosis 13 1.6 Reinsertion of Components 1 0.1
Metal Related Pathology 11 1.4 TOTAL 802 100.0
Wear Glenoid Insert 9 1.1

Note: Humeral heads are replaced when the humeral component
Malposition 8 1.0 is revised
Lysis 4 0.5
Other 32 4.0
TOTAL 802 100.0
Figure ST8 Cumulative Incidence Revision Diagnosis Total Conventional

of Primary Total Conventional Shoulder Replacement
5.0%
Loosening
4.0% Implant Breakage Glenoid Insert
Infection
3.0%
2.0%
1.0%
0.0%
0 1 2 3 4 5 6 7 8 9 10

a o a .o rg.a u 273

Age and Gender
There is no difference in the rate of revision When a modular metal backed glenoid was
between patients aged less than 55 years revised, 78.4% retained the metal glenoid
compared to those aged 55 to 64 years. component and replaced the modular insert
Patients aged 65 to 74 years and 75 years or with a glenosphere. The humeral stem was also
older have a lower rate of revision compared revised in only a small number of these revisions
to patients aged less than 55 years (Table ST27 (15 out of the total 360 procedures).
and Figure ST9).
The above analysis was repeated excluding the
There is no difference in the rate of revision SMR L2 and the results remained consistent
between males and females (Table ST28 and (Table ST32 and Figure ST14).
Figure ST10).
Pegged and keeled all polyethylene glenoid
Fixation
prostheses were also compared. The majority of
Cementless fixation has a higher rate of revision all polyethylene glenoid prostheses are pegged
compared to both cemented and hybrid (84.9%). There is no difference in the rate of
fixation (glenoid cemented). There is no revision between these prostheses (Table ST33
difference between cemented and hybrid and Figure ST15).
fixation (glenoid cemented) (Table ST29 and
Figure ST11). The use of cross-linked polyethylene (XLPE)
glenoids has increased from 11.1% in 2008 to
The fixation analysis was repeated excluding 38.6% in 2016 (Figure ST16). XLPE glenoids have
the SMR L2 prosthesis as it has been withdrawn. a lower cumulative percent revision at seven
The outcome of fixation remained the same, years compared to non XLPE glenoids (2.6%
with cementless fixation of the glenoid being compared to 11.4%) (Table ST34 and Figure
associated with a higher rate of revision when ST17). This is also the case when all polyethylene
the SMR L2 was excluded (Table ST30 and glenoids are compared (Table ST35 and Figure
Figure ST12). ST18). However, it remains uncertain if these
differences are due to the XLPE or the prosthesis
it is used with.
The rate of revision is increased if the glenoid

is not cemented. Humeral Heads
Humeral head sizes less than 44 mm have the
highest rate of revision. This decreases with
Glenoid Type and Design increasing head size, with humeral heads larger
than 50mm having the lowest rate of revision
A further analysis was undertaken to determine
(Table ST36 and Figure ST19). A comparison of
the impact of glenoid type. There are three
revision diagnoses is shown in Figure ST20.
broad glenoid types: modular metal backed,
non modular metal backed and all
The outcomes of the most commonly used
polyethylene. All polyethylene glenoid
prosthesis combinations are listed in Table ST37.
prostheses were used in 70.7% of primary total
The most commonly used cementless prosthesis
conventional shoulder replacements. These
combinations are listed in Table ST38. The most
prostheses have a lower rate of revision
commonly used prosthesis combinations with
compared to modular and non modular metal
hybrid (glenoid cemented) fixation are listed in
backed glenoid prostheses. A modular metal
Table ST39.
backed glenoid has a higher rate of revision
compared to a non modular metal backed
glenoid (Table ST31 and Figure ST13).

Table ST27 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Age (Primary Diagnosis OA)
N N
Revised Total
<55 46 481 3.9 (2.4, 6.1) 8.2 (5.8, 11.4) 9.7 (7.1, 13.3) 16.4 (11.9, 22.3)
55-64 200 2377 3.3 (2.7, 4.2) 7.3 (6.3, 8.6) 9.8 (8.5, 11.3) 11.9 (10.3, 13.8) 14.6 (11.8, 18.2)
65-74 314 4786 2.9 (2.4, 3.4) 5.9 (5.3, 6.7) 7.9 (7.0, 8.8) 8.8 (7.8, 10.0) 10.6 (9.1, 12.2)
≥75 185 3161 2.5 (2.0, 3.2) 5.1 (4.4, 6.0) 6.6 (5.7, 7.7) 7.9 (6.7, 9.2) 8.8 (7.4, 10.5)
TOTAL 745 10805
Figure ST9 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Age (Primary Diagnosis OA)
30%
<55
55-64 vs <55
55-64
25% ≥75
65-74 vs <55
20%
≥75 vs <55
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

<55 481 391 269 173 85 19 2
55-64 2377 2025 1383 892 433 89 14
65-74 4786 4103 2827 1707 815 162 27
≥75 3161 2782 1976 1213 551 108 19

a o a .o rg.a u 275
Table ST28 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Gender (Primary Diagnosis
OA)
N N
Revised Total
Male 321 4603 2.7 (2.3, 3.3) 6.1 (5.4, 6.9) 8.6 (7.7, 9.7) 10.3 (9.2, 11.6) 11.4 (9.9, 13.2)
Female 424 6202 3.0 (2.6, 3.5) 6.1 (5.5, 6.8) 7.6 (6.9, 8.4) 9.1 (8.2, 10.0) 11.2 (9.7, 12.8)
TOTAL 745 10805
Figure ST10 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Gender (Primary Diagnosis
OA)
30%
Male
Male vs Female
Female
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Male 4603 3925 2661 1576 742 155 24
Female 6202 5376 3794 2409 1142 223 38

Table ST29 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Fixation (Primary Diagnosis
OA)
N N
Revised Total
Cemented 42 862 1.9 (1.2, 3.1) 4.0 (2.8, 5.6) 4.4 (3.1, 6.1) 5.8 (4.2, 8.1) 6.3 (4.5, 8.8)
Cementless 482 3094 6.2 (5.4, 7.1) 13.4 (12.2, 14.8) 17.9 (16.4, 19.6) 20.7 (18.9, 22.6) 24.0 (21.3, 27.0)
Hybrid (Glenoid Cemented) 213 6784 1.4 (1.2, 1.8) 2.8 (2.4, 3.3) 3.7 (3.2, 4.2) 4.6 (3.9, 5.4) 5.8 (4.7, 7.1)
Hybrid (Glenoid Cementless) 8 65 9.6 (4.4, 20.1) 11.7 (5.7, 23.2) 15.2 (7.6, 29.4)
TOTAL 745 10805
Figure ST11 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Fixation (Primary Diagnosis
OA)
30%
Cemented
Cemented vs Hybrid (Glenoid Cemented)
Cementless
Hybrid (Glenoid Cemented) Entire Period: HR=1.34 (0.96, 1.87),p=0.083
25%
Cementless vs Hybrid (Glenoid Cemented)
0 - 6Mth: HR=3.35 (2.41, 4.66),p<0.001
20% 6Mth+: HR=5.53 (4.62, 6.63),p<0.001
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Cemented 862 797 647 456 241 52 6
Cementless 3094 2634 1809 1092 500 96 18
Hybrid (Glenoid Cemented) 6784 5821 3964 2420 1138 227 38

a o a .o rg.a u 277
Table ST30 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Fixation (Primary Diagnosis
OA, excluding SMR L2)
N N
Revised Total
Cemented 42 862 1.9 (1.2, 3.1) 4.0 (2.8, 5.6) 4.4 (3.1, 6.1) 5.8 (4.2, 8.1) 6.3 (4.5, 8.8)
Cementless 234 2308 5.0 (4.1, 6.0) 9.5 (8.3, 10.9) 11.4 (10.0, 13.1) 13.4 (11.7, 15.4) 17.1 (14.3, 20.3)
Hybrid (Glenoid Cemented) 213 6784 1.4 (1.2, 1.8) 2.8 (2.4, 3.3) 3.7 (3.2, 4.2) 4.6 (3.9, 5.4) 5.8 (4.7, 7.1)
Hybrid (Glenoid Cementless) 5 52 7.9 (3.1, 19.8) 10.9 (4.6, 24.6) 10.9 (4.6, 24.6)
TOTAL 494 10006
Figure ST12 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Fixation (Primary Diagnosis
OA, excluding SMR L2)
30%
Cemented
Cemented vs Hybrid (Glenoid Cemented)
Cementless
Hybrid (Glenoid Cemented) Entire Period: HR=1.33 (0.96, 1.85),p=0.090
25%
Cementless vs Hybrid (Glenoid Cemented)
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Cemented 862 797 647 456 241 52 6
Cementless 2308 1930 1217 666 481 96 18
Hybrid (Glenoid Cemented) 6784 5821 3964 2420 1138 227 38

Table ST31 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Glenoid Type (Primary
Diagnosis OA)
N N
Glenoid Type 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Revised Total
Modular Metal Backed 459 2509 7.2 (6.2, 8.3) 15.3 (13.9, 16.9) 20.4 (18.7, 22.3) 23.4 (21.4, 25.5) 26.4 (23.6, 29.4)
All Polyethylene 255 7634 1.5 (1.2, 1.8) 3.0 (2.6, 3.4) 3.8 (3.3, 4.3) 4.7 (4.1, 5.5) 5.8 (4.8, 6.9) 7.0 (5.3, 9.2)
Non Modular Metal Backed 31 662 2.9 (1.8, 4.6) 5.2 (3.6, 7.5) 5.5 (3.8, 7.9)
TOTAL 745 10805
Figure ST13 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Glenoid Type (Primary
Diagnosis OA)
30%
Modular Metal Backed Modular Metal Backed vs All Polyethylene
All Polyethylene
Non Modular Metal Backed
25%
Non Modular Metal Backed vs All Polyethylene
20% Modular Metal Backed vs

0 - 3Mth: HR=1.87 (1.04, 3.37),p=0.037
15%
3Mth - 9Mth: HR=3.29 (2.09, 5.18),p<0.001
9Mth - 1Yr: HR=3.62 (2.02, 6.51),p<0.001
1Yr - 2Yr: HR=3.58 (2.28, 5.62),p<0.001
10%
2Yr+: HR=3.73 (2.44, 5.69),p<0.001
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Modular Metal Backed 2509 2143 1514 947 480 99 18
All Polyethylene 7634 6616 4631 2882 1379 279 44
Non Modular Metal Backed 662 542 310 156 25 0 0

a o a .o rg.a u 279
Table ST32 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Glenoid Type (Primary
Diagnosis OA, excluding SMR L2)
N N
Glenoid Type 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Revised Total
Modular Metal Backed 208 1710 6.0 (4.9, 7.2) 11.1 (9.6, 12.8) 13.4 (11.6, 15.5) 15.7 (13.6, 18.1) 19.0 (16.1, 22.4)
All Polyethylene 255 7634 1.5 (1.2, 1.8) 3.0 (2.6, 3.4) 3.8 (3.3, 4.3) 4.7 (4.1, 5.5) 5.8 (4.8, 6.9) 7.0 (5.3, 9.2)
Non Modular Metal Backed 31 662 2.9 (1.8, 4.6) 5.2 (3.6, 7.5) 5.5 (3.8, 7.9)
TOTAL 494 10006
Figure ST14 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Glenoid Type (Primary
Diagnosis OA, excluding SMR L2)
30%
Modular Metal Backed Modular Metal Backed vs All Polyethylene
All Polyethylene
25%
Non Modular Metal Backed vs All Polyethylene
20% Modular Metal Backed vs

15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Modular Metal Backed 1710 1428 911 513 461 99 18
All Polyethylene 7634 6616 4631 2882 1379 279 44
Non Modular Metal Backed 662 542 310 156 25 0 0

Table ST33 Cumulative Percent Revision of All Polyethylene Cemented Primary Total Conventional Shoulder Replacement by
Glenoid Design (Primary Diagnosis OA)
N N
Glenoid Design 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Revised Total
Keeled Cemented 44 1115 1.1 (0.6, 2.0) 3.4 (2.4, 4.7) 4.3 (3.1, 5.9) 5.2 (3.8, 7.3) 6.1 (4.3, 8.6)
Pegged Cemented 208 6478 1.5 (1.3, 1.9) 2.9 (2.5, 3.4) 3.6 (3.1, 4.2) 4.6 (3.9, 5.4) 5.7 (4.6, 7.0)
TOTAL 252 7593
Figure ST15 Cumulative Percent Revision of All Polyethylene Cemented Primary Total Conventional Shoulder Replacement by
Glenoid Design (Primary Diagnosis OA)
30%
Keeled Cemented
Keeled Cemented vs Pegged Cemented
Pegged Cemented
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Keeled Cemented 1115 1015 762 494 231 62 9
Pegged Cemented 6478 5565 3841 2376 1146 217 35
Figure ST16 Proportion of Primary Total Conventional Shoulder Replacement by Polyethylene Type (All Diagnoses)
100%
90%
80%
70%
60%
50%
40%
30%
20%
Non XLPE
10% XLPE
0%
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20

a o a .o rg.a u 281
Table ST34 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement using All Types of Glenoid by
Polyethylene Type (Primary Diagnosis OA)
N N
Revised Total
Non XLPE 671 7868 3.4 (3.0, 3.9) 7.3 (6.7, 8.0) 9.6 (8.9, 10.4) 11.4 (10.6, 12.4) 13.0 (11.8, 14.3) 14.1 (12.4, 16.0)
XLPE 62 2855 1.5 (1.1, 2.0) 2.3 (1.8, 3.0) 2.5 (1.9, 3.2) 2.6 (2.0, 3.5)
TOTAL 733 10723
Note: Excludes 82 procedures with unknown bearing surface, most of which are customised prostheses where the type of polyethylene used
has not been defined
Figure ST17 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement using All Types of Glenoid by
Polyethylene Type (Primary Diagnosis OA)

30%
Non XLPE Non XLPE vs XLPE
XLPE
0 - 1.5Yr: HR=2.27 (1.69, 3.04),p<0.001
25% 1.5Yr+: HR=9.06 (4.83, 16.99),p<0.001

20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Non XLPE 7868 6861 4927 3197 1557 343 56
XLPE 2855 2363 1465 733 276 27 6

Table ST35 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement using All Polyethylene Glenoids
N N
Revised Total
Non XLPE 193 4767 1.5 (1.2, 1.9) 3.3 (2.8, 3.9) 4.3 (3.7, 5.0) 5.5 (4.7, 6.4) 6.5 (5.4, 7.7)
XLPE 62 2855 1.5 (1.1, 2.0) 2.3 (1.8, 3.0) 2.5 (1.9, 3.2) 2.6 (2.0, 3.5)
TOTAL 255 7622
Note: Excludes 12 procedures with unknown bearing surface most of which are customised prostheses where the type of polyethylene used
has not been defined
Figure ST18 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement using All Polyethylene Glenoids

30%
Non XLPE Non XLPE vs XLPE
XLPE
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Non XLPE 4767 4243 3166 2149 1103 252 38
XLPE 2855 2363 1465 733 276 27 6

a o a .o rg.a u 283
Table ST36 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Humeral Head Size (Primary
Diagnosis OA)
N N
Revised Total
<44mm 115 1417 3.5 (2.6, 4.6) 7.9 (6.5, 9.6) 8.9 (7.3, 10.7) 10.4 (8.5, 12.6)
44-50mm 496 6891 3.1 (2.7, 3.5) 6.4 (5.8, 7.0) 8.3 (7.6, 9.1) 10.0 (9.1, 10.9) 11.5 (10.3, 12.8) 13.0 (11.0, 15.4)
>50mm 133 2493 2.1 (1.6, 2.8) 4.3 (3.5, 5.3) 6.6 (5.5, 7.9) 8.0 (6.6, 9.7) 9.0 (7.1, 11.4)
TOTAL 744 10801
Note: Excludes four procedures with unknown humeral head size
Figure ST19 Cumulative Percent Revision of Primary Total Conventional Shoulder Replacement by Humeral Head Size (Primary
Diagnosis OA)

30%
<44mm <44mm vs >50mm
44-50mm
>50mm
25%
44-50mm vs >50mm
20% <44mm vs 44-50mm

15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

<44mm 1417 1220 823 517 232 38 4
44-50mm 6891 5941 4146 2542 1218 239 40
>50mm 2493 2137 1484 924 433 101 18

Figure ST20 Cumulative Incidence Revision Diagnosis of Primary Total Conventional Shoulder Replacement by Humeral Head
Size (Primary Diagnosis OA)
<44mm 44-50mm
5.0% 5.0%
Rotator Cuff Insufficiency Rotator Cuff Insufficiency
Loosening Loosening
4.0% Implant Breakage Glenoid Insert 4.0% Implant Breakage Glenoid Insert
Infection Infection
3.0% 3.0%
2.0% 2.0%
1.0% 1.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10
>50mm
5.0%
Loosening
4.0% Implant Breakage Glenoid Insert
Infection
3.0%
2.0%
1.0%
0.0%
0 1 2 3 4 5 6 7 8 9 10

a o a .o rg.a u 285
Table ST37 Cumulative Percent Revision of All Primary Total Conventional Shoulder Replacement by Prosthesis Combination
N N
Humeral Stem Glenoid 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Revised Total
Aequalis Aequalis 52 1630 1.4 (0.9, 2.1) 2.6 (1.9, 3.6) 3.3 (2.5, 4.3) 4.2 (3.1, 5.7) 4.2 (3.1, 5.7)
Aequalis
Aequalis 2 276 0.4 (0.1, 3.0)
Ascend
Affinis Affinis 11 173 0.0 (0.0, 0.0) 1.8 (0.6, 5.5) 5.1 (2.6, 10.0) 6.2 (3.2, 11.7)
Ascend Aequalis 10 331 1.6 (0.7, 3.8) 3.6 (1.9, 7.0)
Bigliani/Flatow Bigliani/Flatow 9 141 2.1 (0.7, 6.5) 3.6 (1.5, 8.5) 3.6 (1.5, 8.5) 5.6 (2.7, 11.5)
Bigliani/ Bigliani/
22 365 2.2 (1.1, 4.4) 5.2 (3.3, 8.3) 6.5 (4.2, 9.9) 7.1 (4.6, 10.9)
Flatow TM Flatow
Bigliani/Flatow Bigliani/Flatow
26 583 2.5 (1.5, 4.2) 5.0 (3.3, 7.4) 5.3 (3.6, 7.8)
TM TM
Epoca Epoca 3 50 0.0 (0.0, 0.0) 4.8 (1.2, 17.7) 7.9 (2.6, 22.9) 7.9 (2.6, 22.9)
Equinoxe Equinoxe 6 155 3.0 (1.1, 7.8)
Global AP Global 22 439 1.2 (0.5, 2.8) 3.7 (2.2, 6.1) 4.3 (2.7, 6.8) 6.6 (4.2, 10.4)
Global
Global AP 46 1977 1.6 (1.2, 2.3) 2.3 (1.7, 3.1) 2.5 (1.8, 3.3) 2.7 (2.0, 3.7)
Advantage
Global
Global 21 495 1.7 (0.8, 3.3) 3.4 (2.1, 5.5) 3.4 (2.1, 5.5) 4.9 (3.2, 7.7) 4.9 (3.2, 7.7)
Advantage
Global Global
3 158 0.0 (0.0, 0.0) 2.3 (0.6, 9.2) 2.3 (0.6, 9.2)
Advantage Advantage
Global
Global Unite 0 404 0.0 (0.0, 0.0)
Advantage
SMR SMR 16 398 1.8 (0.9, 3.8) 3.8 (2.3, 6.4) 4.2 (2.5, 6.8) 4.2 (2.5, 6.8)
SMR SMR L1 183 1648 5.7 (4.6, 6.9) 10.6 (9.1, 12.3) 12.4 (10.7, 14.4) 13.9 (12.0, 16.2) 17.4 (14.4, 20.9)
SMR SMR L2 250 798 9.7 (7.8, 12.0) 22.6 (19.8, 25.6) 30.2 (27.1, 33.6)
Solar Solar 6 169 0.6 (0.1, 4.1) 2.4 (0.9, 6.2) 3.2 (1.3, 7.5) 3.2 (1.3, 7.5)
Turon Turon 1 70 1.5 (0.2, 10.0) 1.5 (0.2, 10.0)
Other (35) 44 288 4.4 (2.5, 7.6) 9.1 (6.1, 13.4) 15.5 (11.3, 21.1) 19.6 (14.7, 26.0)
TOTAL 745 10805
Table ST38 Cumulative Percent Revision of Cementless Primary Total Conventional Shoulder Replacement by Prosthesis
Combination (Primary Diagnosis OA)
Humeral N N
Glenoid 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Stem Revised Total
Bigliani/ Bigliani/
24 556 2.3 (1.3, 4.0) 4.8 (3.2, 7.3) 5.2 (3.4, 7.8)
Flatow TM Flatow TM
Epoca Epoca 3 36 0.0 (0.0, 0.0) 7.1 (1.8, 25.7) 12.6 (4.1, 35.1)
SMR SMR L1 180 1618 5.6 (4.6, 6.9) 10.6 (9.0, 12.3) 12.4 (10.6, 14.4) 13.9 (11.9, 16.2) 17.4 (14.4, 21.0)
SMR SMR L2 247 785 9.6 (7.7, 11.9) 22.7 (19.9, 25.8) 30.3 (27.2, 33.7)
Univers 3D Univers 3D 11 26 7.7 (2.0, 27.4) 19.2 (8.5, 40.2) 23.3 (11.2, 44.7) 35.4 (20.2, 57.1) 39.4 (23.5, 60.9) 45.5 (27.8, 67.7)
Vaios Vaios 11 24 16.7 (6.6, 38.5) 29.2 (15.1, 51.6) 44.3 (26.4, 67.3)
Other (14) 3 22 5.3 (0.8, 31.9) 5.3 (0.8, 31.9) 17.1 (4.1, 57.1) 17.1 (4.1, 57.1)
TOTAL 482 3094

Table ST39 Cumulative Percent Revision of Hybrid (Glenoid Cemented) Primary Total Conventional Shoulder Replacement by
Prosthesis Combination (Primary Diagnosis OA)
N N
Humeral Stem Glenoid 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Revised Total
Aequalis Ascend Aequalis 2 265 0.4 (0.1, 3.1)
Affinis Affinis 11 171 0.0 (0.0, 0.0) 1.8 (0.6, 5.6) 5.2 (2.6, 10.1) 6.2 (3.2, 11.8)
Ascend Aequalis 9 314 1.7 (0.7, 4.0) 3.3 (1.6, 6.6)
Bigliani/Flatow Bigliani/Flatow 7 120 2.5 (0.8, 7.6) 4.3 (1.8, 9.9) 4.3 (1.8, 9.9) 5.4 (2.5, 11.7)
Bigliani/Flatow TM Bigliani/Flatow 16 337 1.5 (0.6, 3.6) 4.0 (2.3, 7.0) 5.4 (3.3, 8.8) 5.4 (3.3, 8.8)
Global AP Global 21 385 1.3 (0.6, 3.1) 4.3 (2.6, 7.0) 5.0 (3.1, 7.9) 7.8 (4.9, 12.2)
Global AP Global Advantage 42 1748 1.7 (1.2, 2.4) 2.4 (1.8, 3.3) 2.6 (1.9, 3.5) 2.9 (2.0, 4.0)
Global Advantage Global 14 404 1.5 (0.7, 3.4) 3.5 (2.0, 5.9) 3.5 (2.0, 5.9) 4.0 (2.3, 6.7) 4.0 (2.3, 6.7)
Global Advantage Global Advantage 3 133 0.0 (0.0, 0.0) 2.8 (0.7, 11.1)
Global Unite Global Advantage 0 370 0.0 (0.0, 0.0)
SMR SMR 14 382 1.9 (0.9, 4.0) 3.4 (1.9, 5.9) 3.8 (2.2, 6.4) 3.8 (2.2, 6.4)
Solar Solar 4 114 0.9 (0.1, 6.1) 1.8 (0.4, 6.9) 2.9 (0.9, 8.8) 2.9 (0.9, 8.8)
Turon Turon 0 64 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
11.9 (7.1,
Other (26) 14 179 1.7 (0.6, 5.3) 4.0 (1.8, 8.8) 9.5 (5.5, 16.4)
19.6)
TOTAL 213 6784

a o a .o rg.a u 287
PRIMARY TOTAL REVERSE SHOULDER REPLACEMENT

DEMOGRAPHICS
There have been 15,781 primary total reverse Figure ST22 Proportion of Primary Total Reverse Shoulder
shoulder replacement procedures reported to Replacement by Gender
the Registry. This is an increase of 3,419
100%
procedures compared to the previous report. Male
Female
Primary total reverse shoulder replacement has 90%
increased from 43.3% of all total shoulder 80%
replacements in 2008 to 69.3% in 2016.
70%
The proportion of total reverse shoulder 60%
replacements for osteoarthritis declined from 50%

57.8% in 2008 to 40.6% in 2013, increasing to
40%
45.1% in 2016. The diagnosis of rotator cuff
arthropathy was added to the procedure form 30%
in 2008. The proportion of primary total reverse 20%

shoulder procedures undertaken for rotator cuff 10%
arthropathy increased from 21.0% in 2008 to
0%
37.9% in 2013, and is 33.9% in 2016. The
08
09
10
11
12
13
14
15
16
proportion of total reverse shoulder
20
20
20
20
20
20
20
20
20
replacements for fracture has increased from
12.0% in 2008 to 16.0% in 2016 (Figure ST21). Primary total reverse shoulder replacement is
most commonly undertaken in females (65.6%)
(Table ST40). There has been minimal change in
Figure ST21 Proportion of Primary Total Reverse Shoulder gender distribution since 2008 (Figure ST22). The
Replacement by Primary Diagnosis mean age is 75.6 years for females and 73.1
100%
years for males. The proportion of patients aged
Rotator Cuff Arthropathy Other
75 years or older has declined from 61.4% in
90%
2010 to 47.0% in 2016 (Figure ST23).
80%
70%
osteoarthritis (45.5%), rotator cuff arthropathy
60%
(34.0%) and fracture (15.0%) (Table ST41).
50%
40%
30% osteoarthritis (45.5%), rotator cuff arthropathy
20% (34.0%) and fracture (15.0%).
10%
0%
The majority of procedures use cementless
08
09
10
11
12
13
14
15
16
fixation (75.1%). Hybrid fixation (humerus

20
20
20
20
20
20
20
20
20
cemented) is used in 23.4% of procedures.

There has been little variation in the use of
fixation since 2008 (Figure ST24).
The most used humeral stems are the Delta

Xtend, SMR and Aequalis (Table ST42). The most
used glenoid prostheses are the Delta Xtend,
SMR L1 and Aequalis (Table ST43).
Table ST40 Primary Total Reverse Shoulder Replacement by Age and Gender

Male 5434 34.4% 24 96 74 73.1 8.1
Female 10347 65.6% 14 102 76 75.6 7.9
TOTAL 15781 100.0% 14 102 75 74.7 8.1

Figure ST23 Proportion of Primary Total Reverse Shoulder Replacement by Age

100%
<55 55-64
90% 65-74 ≥75
80%
70%
60%
50%
40%
30%
20%
10%
0%
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
Figure ST24 Proportion of Primary Total Reverse Shoulder Replacement by Fixation
100%
Cemented
90% Cementless
Hybrid (Glenoid Cemented)
80% Hybrid (Humerus Cemented)
70%
60%
50%
40%
30%
20%
10%
0%
08
09
10
11
12
13
14
15
16
20
20
20
20
20
20
20
20
20
Table ST41 Primary Total Reverse Shoulder Replacement by Primary Diagnosis and Gender
Male Female TOTAL

Osteoarthritis 2626 48.3 4548 44.0 7174 45.5
Fracture 355 6.5 2010 19.4 2365 15.0
Instability 62 1.1 129 1.2 191 1.2
Osteonecrosis 31 0.6 148 1.4 179 1.1
Tumour 52 1.0 53 0.5 105 0.7
Other 2 0.0 4 0.0 6 0.0
TOTAL 5434 100.0 10347 100.0 15781 100.0

a o a .o rg.a u 289
Table ST42 10 Most Used Humeral Stem Prostheses in Primary Total Reverse Shoulder Replacement
2008 2013 2014 2015 2016

262 SMR 713 Delta Xtend 845 Delta Xtend 959 Delta Xtend 1017 Delta Xtend
252 Delta Xtend 567 SMR 633 SMR 729 SMR 909 SMR
76 Aequalis 308 Aequalis 253 Aequalis 265 Aequalis 358 Aequalis
42 Trabecular Metal 142 Trabecular Metal 141 Trabecular Metal 191 Trabecular Metal 205 Trabecular Metal
21 Delta CTA 38 RSP 113 RSP 142 RSP 192 Comprehensive
2 Custom Made (Lima) 36 Comprehensive 83 Aequalis Ascend 103 Comprehensive 176 RSP
Generic Humeral
1 14 Equinoxe 80 Comprehensive 103 Equinoxe 168 Equinoxe
Stem
1 Promos 13 Global Unite 45 Global Unite 67 Global Unite 104 Global Unite
12 Affinis 32 Equinoxe 46 Aequalis Ascend 92 Aequalis Ascend
7 Vaios 18 Anatomical Shoulder 44 Anatomical Shoulder 79 Affinis
10 Most Used
657 (8) 100.0% 1850 (10) 99.4% 2243 (10) 99.1% 2649 (10) 98.7% 3300 (10) 99.0%
Remainder
0 (0) 0% 11 (3) 0.6% 21 (4) 0.9% 35 (3) 1.3% 32 (3) 1.0%
TOTAL
657 (8) 100.0% 1861 (13) 100.0% 2264 (14) 100.0% 2684 (13) 100.0% 3332 (13) 100.0%
Table ST43 10 Most Used Glenoid Prostheses in Primary Total Reverse Shoulder Replacement
2008 2013 2014 2015 2016

263 SMR L1 726 Delta Xtend 890 Delta Xtend 1026 Delta Xtend 1121 Delta Xtend
252 Delta Xtend 562 SMR L1 628 SMR L1 728 SMR L1 897 SMR L1
76 Aequalis 313 Aequalis 338 Aequalis 311 Aequalis 451 Aequalis
42 Trabecular Metal 144 Trabecular Metal 150 Trabecular Metal 216 Trabecular Metal 231 Trabecular Metal
Comprehensive
21 Delta CTA 38 RSP 113 RSP 142 RSP 178
Reverse
Comprehensive Comprehensive
1 Generic Metaglene 36 78 103 Equinoxe 176 RSP
Reverse Reverse
Comprehensive
1 Promos 14 Equinoxe 32 Equinoxe 101 164 Equinoxe
Reverse
1 SMR 12 Affinis 10 Affinis 28 Affinis 79 Affinis
7 Vaios 10 Anatomical Shoulder 19 Anatomical Shoulder 7 SMR Axioma
6 Mets 9 Mets 6 Mets 6 Anatomical Shoulder
10 Most Used
657 (8) 100.0% 1858 (10) 99.8% 2258 (10) 99.7% 2680 (10) 99.9% 3310 (10) 99.3%
Remainder
0 (0) 0% 3 (2) 0.2% 6 (3) 0.3% 4 (2) 0.1% 22 (8) 0.7%
TOTAL
657 (8) 100.0% 1861 (12) 100.0% 2264 (13) 100.0% 2684 (12) 100.0% 3332 (18) 100.0%


Fracture has a higher rate of revision in the first The four most common types of revision are:
three months compared to osteoarthritis. After replacement of both cup (liner) and
this time, there is no difference in the rate of glenosphere (23.2%), cup only (20.1%), humeral
revision of total reverse shoulder replacement component only (20.1%), and humeral head
when primary diagnosis is considered (Table only (converted to a hemi arthroplasty, 16.0%)
ST44 and Figure ST25). (Table ST46). When only the humeral
component is revised, this may be associated
Reason for Revision
with exchange of the epiphysis and/or humeral
Instability/dislocation is the most common stem and additional minor components such as
reason for revision (35.4%), followed by infection the liner.
(19.1%), loosening (18.2%) and fracture (13.7%)
(Table ST45 and Figure ST26).
Table ST44 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Primary Diagnosis
N N
Revised Total
Osteoarthritis 249 7174 2.5 (2.1, 2.9) 3.6 (3.1, 4.1) 4.3 (3.7, 4.9) 5.1 (4.4, 5.9) 6.6 (5.2, 8.3)
Rotator Cuff Arthropathy 207 5363 2.9 (2.4, 3.4) 4.0 (3.5, 4.7) 5.1 (4.3, 5.9) 5.3 (4.5, 6.2) 7.4 (5.4, 10.1)
Fracture 80 2365 2.8 (2.2, 3.6) 3.5 (2.8, 4.4) 4.3 (3.4, 5.5) 5.0 (3.8, 6.7)
Rheumatoid Arthritis 16 341 3.4 (1.9, 6.1) 4.7 (2.8, 7.8) 6.4 (3.7, 10.7) 6.4 (3.7, 10.7)
Other (5) 30 538 3.6 (2.3, 5.7) 6.2 (4.1, 9.2) 6.7 (4.5, 10.0) 7.6 (5.0, 11.6)
TOTAL 582 15781
Figure ST25 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Primary Diagnosis
30%
Osteoarthritis
Rotator Cuff Arthropathy vs Osteoarthritis
Rotator Cuff Arthropathy
Fracture Entire Period: HR=1.13 (0.94, 1.36),p=0.186
0 - 3Mth: HR=1.86 (1.35, 2.55),p<0.001
20% 3Mth+: HR=0.74 (0.50, 1.12),p=0.154

15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Osteoarthritis 7174 5438 3122 1684 740 133 17
Rotator Cuff Arthropathy 5363 4051 2255 1008 327 58 15
Fracture 2365 1721 877 362 122 20 2

a o a .o rg.a u 291
Table ST45 Primary Total Reverse Shoulder Replacement Table ST46 Primary Total Reverse Shoulder Replacement
by Reason for Revision by Type of Revision

Instability/Dislocation 206 35.4 Cup/Glenosphere 135 23.2
Infection 111 19.1 Cup Only 117 20.1
Loosening 106 18.2 Humeral Component 117 20.1
Fracture 80 13.7 Humeral Head Only 93 16.0
Dissociation 12 2.1 Glenoid Component 36 6.2
Pain 10 1.7 Humeral/Glenoid 31 5.3
Lysis 8 1.4 Cement Spacer 24 4.1
Incorrect Sizing 7 1.2 Removal of Prostheses 12 2.1
Malposition 6 1.0 Glenosphere Only 5 0.9
Arthrofibrosis 3 0.5 Minor Components 5 0.9
Rotator Cuff Insufficiency 2 0.3 Cement Only 3 0.5
Other 31 5.3 Reoperation 2 0.3
TOTAL 582 100.0 Head/Insert 1 0.2

Reinsertion of Components 1 0.2
TOTAL 582 100.0
Figure ST26 Total

Cumulative Incidence Revision Diagnosis of Reverse
Primary Total Reverse Shoulder Replacement
5.0%
Infection
Loosening
4.0% Fracture
Pain
3.0%
2.0%
1.0%
0.0%
0 1 2 3 4 5 6 7 8 9 10


Age and Gender Glenosphere Size
Age is not a risk factor for revision of total Glenosphere sizes smaller than 38mm have a
reverse shoulder replacement undertaken for higher rate of revision over the entire period
osteoarthritis (Table ST47 and Figure ST27). compared to 38 to 40mm sizes and in the first
three months only when compared to sizes
Males have a higher rate of revision compared larger than 40mm (Table ST51 and Figure ST31).
to females (Table ST48 and Figure ST28). The most common reason for revision is
instability/dislocation (Figure ST32).
Fixation
Fixation is not a risk factor for revision (Table ST49
and Figure ST29), with no difference between Glenosphere sizes smaller than 38mm have
hybrid (humerus cemented) and cementless a higher rate of revision when used for
humeral stems. This is also the case when the osteoarthritis.
SMR L2 prosthesis is excluded from the analysis
The outcomes of the most commonly used total
reverse shoulder prostheses are listed in Table
ST52. The outcomes for the most used prosthesis
combinations using cementless fixation are
listed in Table ST53. The most commonly used
prosthesis combinations using hybrid (humerus
cemented) fixation are listed in Table ST54.

a o a .o rg.a u 293
Table ST47 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Age (Primary Diagnosis OA)
N N
Revised Total
<55 4 77 4.3 (1.4, 12.9) 4.3 (1.4, 12.9) 4.3 (1.4, 12.9) 9.7 (3.0, 28.9)
55-64 33 555 4.0 (2.7, 6.1) 6.3 (4.4, 9.0) 7.6 (5.3, 10.9) 7.6 (5.3, 10.9)
65-74 98 2648 2.5 (2.0, 3.2) 4.1 (3.3, 5.0) 4.8 (3.9, 6.0) 5.7 (4.5, 7.3) 6.8 (5.1, 9.2)
≥75 114 3894 2.2 (1.8, 2.7) 2.9 (2.4, 3.6) 3.5 (2.8, 4.2) 4.2 (3.3, 5.2) 5.7 (3.9, 8.4)
TOTAL 249 7174
Figure ST27 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Age (Primary Diagnosis OA)
30%
<55
55-64 vs <55
55-64
25% ≥75
65-74 vs <55
20%
≥75 vs <55
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

<55 77 55 35 19 10 3 1
55-64 555 403 227 122 57 14 2
65-74 2648 1913 1061 575 278 52 5
≥75 3894 3067 1799 968 395 64 9

Table ST48 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Gender (Primary Diagnosis OA)
N N
Revised Total
Male 124 2626 3.8 (3.1, 4.6) 5.0 (4.1, 6.0) 5.9 (4.8, 7.1) 6.6 (5.3, 8.1) 7.8 (5.9, 10.3)
Female 125 4548 1.7 (1.4, 2.2) 2.8 (2.3, 3.4) 3.4 (2.8, 4.1) 4.2 (3.4, 5.2) 5.9 (4.2, 8.4)
TOTAL 249 7174
Figure ST28 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Gender (Primary Diagnosis OA)
30%
Male
Male vs Female
Female
0 - 3Mth: HR=2.22 (1.48, 3.33),p<0.001
25% 3Mth+: HR=1.43 (1.04, 1.98),p=0.027
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Male 2626 1942 1063 554 244 50 4
Female 4548 3496 2059 1130 496 83 13

a o a .o rg.a u 295
Table ST49 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis OA)
N N
Revised Total
Cemented 1 72 1.6 (0.2, 10.7) 1.6 (0.2, 10.7) 1.6 (0.2, 10.7) 1.6 (0.2, 10.7)
Cementless 203 5692 2.6 (2.2, 3.1) 3.7 (3.2, 4.3) 4.3 (3.7, 5.0) 5.3 (4.4, 6.3) 7.0 (5.4, 9.2)
Hybrid (Glenoid Cemented) 1 45 2.3 (0.3, 15.4) 2.3 (0.3, 15.4)
Hybrid (Humerus Cemented) 44 1365 1.9 (1.2, 2.8) 3.3 (2.4, 4.5) 4.2 (3.1, 5.8) 4.5 (3.3, 6.2)
TOTAL 249 7174
Figure ST29 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis OA)
30%
Cementless Cementless vs Hybrid (Humerus Cemented)
Hybrid (Humerus Cemented)
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Cementless 5692 4270 2416 1300 565 94 17
Hybrid (Humerus Cemented) 1365 1086 648 345 158 33 0

Table ST50 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis OA,
excluding SMR L2)
N N
Revised Total
Cemented 1 72 1.6 (0.2, 10.7) 1.6 (0.2, 10.7) 1.6 (0.2, 10.7) 1.6 (0.2, 10.7)
Cementless 183 5241 2.7 (2.2, 3.2) 3.7 (3.2, 4.4) 4.3 (3.7, 5.0) 5.1 (4.3, 6.1) 6.9 (5.2, 9.1)
TOTAL 228 6693
Figure ST30 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis OA,
excluding SMR L2)

30%
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Cementless 5241 3838 2009 1004 550 94 17

a o a .o rg.a u 297
Table ST51 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Glenosphere Size (Primary
Diagnosis OA)
N N
Glenosphere Size 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Revised Total
<38mm 142 3160 2.9 (2.4, 3.6) 4.5 (3.8, 5.4) 5.3 (4.4, 6.3) 6.3 (5.2, 7.6) 7.7 (5.9, 10.0)
38-40mm 60 2478 2.0 (1.5, 2.6) 2.4 (1.9, 3.2) 2.9 (2.1, 3.8) 3.3 (2.4, 4.6)
>40mm 46 1528 2.3 (1.6, 3.2) 3.3 (2.4, 4.5) 3.9 (2.9, 5.3) 4.4 (3.1, 6.1)
TOTAL 248 7166
Note: Excludes 8 procedures with unknown head size
Figure ST31 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Glenosphere Size (Primary
Diagnosis OA)

30%
<38mm
<38mm vs 38-40mm
38-40mm
>40mm Entire Period: HR=1.66 (1.22, 2.24),p=0.001
25%
>40mm vs 38-40mm
0 - 3Mth: HR=0.54 (0.28, 1.02),p=0.058
20% 3Mth+: HR=1.21 (0.77, 1.90),p=0.411
<38mm vs >40mm
0 - 3Mth: HR=3.07 (1.63, 5.78),p<0.001
15%
3Mth+: HR=1.38 (0.91, 2.08),p=0.129
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

<38mm 3160 2522 1589 961 442 92 16
38-40mm 2478 1809 934 467 199 21 0
>40mm 1528 1104 598 255 98 20 1

Figure ST32 Cumulative Incidence Revision Diagnosis of Primary Total Reverse Shoulder Replacement by Glenosphere Size
<38mm 38-40mm
5.0% 5.0%
Loosening Loosening
Infection Infection
Pain Pain
3.0% 3.0%
2.0% 2.0%
1.0% 1.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10
>40mm
5.0%
Loosening
Infection
4.0% Fracture
Pain
3.0%
2.0%
1.0%
0.0%
0 1 2 3 4 5 6 7 8 9 10

a o a .o rg.a u 299
Table ST52 Cumulative Percent Revision of All Primary Total Reverse Shoulder Replacement by Prosthesis Combination
Glenoid N N
Humeral Stem 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Affinis Affinis 3 81 2.6 (0.7, 10.1) 5.6 (1.7, 17.9)
Comprehensive
Comprehensive 5 220 2.7 (1.1, 6.4)
Reverse
Delta CTA Delta CTA 7 64 7.8 (3.3, 17.8) 9.4 (4.3, 19.8) 9.4 (4.3, 19.8) 11.4 (5.6, 22.5) 11.4 (5.6, 22.5) 11.4 (5.6, 22.5)
Global Unite Delta Xtend 2 91 0.0 (0.0, 0.0)
Promos Promos 2 40 0.0 (0.0, 0.0) 5.0 (1.3, 18.5) 5.0 (1.3, 18.5) 5.0 (1.3, 18.5)
RSP RSP 7 221 3.7 (1.8, 7.6)
SMR SMR L1 73 1705 3.5 (2.7, 4.5) 4.7 (3.6, 5.9) 5.1 (4.0, 6.7) 5.9 (4.4, 7.8) 7.0 (5.0, 9.6)
SMR SMR L2 21 481 2.3 (1.3, 4.1) 3.4 (2.1, 5.5) 4.1 (2.6, 6.4)
Trabecular Metal Trabecular Metal 14 444 1.7 (0.8, 3.5) 3.2 (1.8, 5.8) 4.5 (2.5, 8.0) 4.5 (2.5, 8.0)
Other (18) 3 74 3.0 (0.8, 11.6) 5.7 (1.8, 17.5)
TOTAL 249 7174

Table ST53 Cumulative Percent Revision of Cementless Primary Total Reverse Shoulder Replacement by Prosthesis
Combination (Primary Diagnosis OA)
Glenoid N N
Affinis Affinis 2 50 2.0 (0.3, 13.4) 6.7 (1.5, 26.6)
Comprehensive
Comprehensive 5 206 2.9 (1.2, 6.8)
Reverse
Delta CTA Delta CTA 4 35 8.6 (2.8, 24.3) 8.6 (2.8, 24.3) 8.6 (2.8, 24.3) 11.7 (4.6, 28.3) 11.7 (4.6, 28.3) 11.7 (4.6, 28.3)
Promos Promos 2 38 0.0 (0.0, 0.0) 5.3 (1.3, 19.4) 5.3 (1.3, 19.4) 5.3 (1.3, 19.4)
SMR SMR L1 68 1654 3.4 (2.6, 4.5) 4.4 (3.4, 5.7) 4.9 (3.7, 6.4) 5.7 (4.2, 7.6) 6.8 (4.8, 9.5)
SMR SMR L2 20 451 2.2 (1.2, 4.1) 3.4 (2.1, 5.5) 4.2 (2.6, 6.6)
Trabecular Metal Trabecular Metal 11 393 1.9 (0.9, 3.9) 2.7 (1.4, 5.2) 3.4 (1.8, 6.5)
Other (16) 5 82 5.2 (2.0, 13.3) 7.3 (3.0, 17.2)
TOTAL 203 5692
Table ST54 Cumulative Percent Revision of Hybrid (Humerus Cemented) Primary Total Reverse Shoulder Replacement by
Prosthesis Combination (Primary Diagnosis OA)
Glenoid N N
Aequalis Aequalis 7 203 2.0 (0.8, 5.3) 2.7 (1.1, 6.5) 4.6 (2.2, 9.8)
Affinis Affinis 1 29 4.2 (0.6, 26.1)
Delta CTA Delta CTA 3 29 6.9 (1.8, 24.9) 10.5 (3.5, 29.1) 10.5 (3.5, 29.1) 10.5 (3.5, 29.1) 10.5 (3.5, 29.1)
RSP RSP 3 167 2.2 (0.7, 6.8)
SMR SMR L1 5 46 6.9 (2.3, 19.9) 12.6 (5.4, 27.8) 12.6 (5.4, 27.8) 12.6 (5.4, 27.8)
SMR SMR L2 1 28 3.6 (0.5, 22.8) 3.6 (0.5, 22.8) 3.6 (0.5, 22.8)
Trabecular Metal Trabecular Metal 3 44 0.0 (0.0, 0.0) 8.4 (2.2, 29.9) 13.8 (4.6, 37.4) 13.8 (4.6, 37.4)
Other (10) 3 60 1.9 (0.3, 12.6)
TOTAL 44 1365

a o a .o rg.a u 301
OUTCOME FOR ROTATOR CUFF ARTHROPATHY

Age is not a risk factor for revision of total There is no difference in the rate of revision of
reverse shoulder replacement undertaken for the different glenosphere sizes for rotator cuff
rotator cuff arthropathy (Table ST55 and Figure arthropathy (Table ST59 and Figure ST37).
ST33). Instability/dislocation is the most common
reason for early revision for glenosphere sizes
Males have a higher rate of revision compared 40mm or less (Figure ST38).
to females (Table ST56 and Figure ST34).
The outcomes of the most commonly used
Fixation prosthesis combinations are listed in Table ST60.
The most commonly used prosthesis
Fixation is not a risk factor for revision (Table ST57
combinations using cementless fixation for
and Figure ST35). This is also the case when the
rotator cuff arthropathy are listed in Table ST61.
SMR L2 total reverse shoulder prosthesis is
The most commonly used prosthesis
excluded from the analysis (Table ST58 and
combinations using hybrid (humerus cemented)
Figure ST36).
fixation for rotator cuff arthropathy are listed in
Table ST62.
Table ST55 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Age (Primary Diagnosis Rotator
Cuff Arthropathy)
N N
Revised Total
<55 1 37 2.7 (0.4, 17.7) 2.7 (0.4, 17.7) 2.7 (0.4, 17.7)
55-64 20 392 3.3 (1.8, 5.9) 7.2 (4.5, 11.2) 7.9 (5.0, 12.3)
65-74 75 1985 2.7 (2.1, 3.6) 3.9 (3.0, 4.9) 5.4 (4.1, 7.0) 5.7 (4.3, 7.4)
≥75 111 2949 2.9 (2.4, 3.6) 3.8 (3.1, 4.6) 4.6 (3.7, 5.6) 4.8 (3.9, 5.9)
TOTAL 207 5363
Figure ST33 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Age (Primary Diagnosis Rotator
Cuff Arthropathy)
20%
55-64 55-64 vs ≥75
65-74
≥75
16% 65-74 vs ≥75

14%
55-64 vs 65-74
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10

55-64 392 266 138 64 22 3 1
65-74 1985 1459 807 347 122 24 6
≥75 2949 2300 1298 592 181 30 8

Table ST56 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Gender (Primary Diagnosis Rotator
Cuff Arthropathy)
N N
Revised Total
Male 107 2225 3.6 (2.8, 4.4) 5.2 (4.2, 6.3) 6.4 (5.2, 7.9) 7.0 (5.6, 8.8)
Female 100 3138 2.4 (1.9, 3.0) 3.3 (2.6, 4.0) 4.1 (3.3, 5.1) 4.1 (3.3, 5.1)
TOTAL 207 5363
Figure ST34 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Gender (Primary Diagnosis Rotator
Cuff Arthropathy)
30%
Male
Male vs Female
Female
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Male 2225 1632 851 355 116 26 6
Female 3138 2419 1404 653 211 32 9

a o a .o rg.a u 303
Table ST57 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis Rotator
Cuff Arthropathy)
N N
Revised Total
Cemented 0 13 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Cementless 184 4608 3.0 (2.5, 3.5) 4.2 (3.6, 4.9) 5.3 (4.5, 6.2) 5.4 (4.6, 6.4) 7.8 (5.6, 10.7)
Hybrid (Humerus Cemented) 22 706 2.1 (1.3, 3.6) 3.3 (2.1, 5.1) 3.7 (2.4, 5.8)
TOTAL 207 5363
Figure ST35 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis Rotator
Cuff Arthropathy)
30%
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Cementless 4608 3470 1920 876 290 55 14

Table ST58 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis Rotator
Cuff Arthropathy, excluding SMR L2)
N N
Revised Total
Cemented 0 13 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Cementless 163 4235 2.9 (2.4, 3.5) 4.1 (3.5, 4.9) 5.2 (4.4, 6.2) 5.4 (4.5, 6.5) 7.8 (5.6, 10.7)
Hybrid (Humerus Cemented) 22 698 2.2 (1.3, 3.7) 3.4 (2.2, 5.2) 3.8 (2.4, 5.9)
TOTAL 186 4982
Figure ST36 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis Rotator
Cuff Arthropathy, excluding SMR L2)
30%
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Cementless 4235 3117 1590 656 285 55 14

a o a .o rg.a u 305
Diagnosis Rotator Cuff Arthropathy)
N N
Revised Total
<38mm 95 2082 3.2 (2.5, 4.1) 4.4 (3.6, 5.5) 5.7 (4.6, 7.1) 5.9 (4.7, 7.4) 9.0 (6.2, 13.0)
38-40mm 70 2072 2.7 (2.1, 3.6) 3.7 (2.9, 4.8) 4.4 (3.4, 5.7) 4.8 (3.6, 6.3)
>40mm 42 1204 2.5 (1.7, 3.6) 3.9 (2.8, 5.3) 4.7 (3.4, 6.4)
TOTAL 207 5358
Note: Excludes five procedures with unknown glenosphere size

30%
<38mm
<38mm vs 38-40mm
38-40mm
25%
>40mm vs 38-40mm
20%
<38mm vs >40mm
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10
Number at Risk 0 Yr 1 Yr 2 Yrs 3 Yrs 4 Yrs 5 Yrs 6 Yrs 7 Yrs 8 Yrs 9 Yrs 10 Yrs
<38mm 2082 1637 1288 1011 745 525 324 198 103 47 15
38-40mm 2072 1544 1106 806 554 346 189 95 31 9 0
>40mm 1204 866 628 434 247 133 58 31 9 1 0

(Primary Diagnosis Rotator Cuff Arthropathy)
<38mm 38-40mm
5.0% 5.0%
Infection Infection
Loosening Loosening
Incorrect Sizing Incorrect Sizing
3.0% 3.0%
2.0% 2.0%
1.0% 1.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10
>40mm
5.0%
Infection
Loosening
4.0% Fracture
Incorrect Sizing
3.0%
2.0%
1.0%
0.0%
0 1 2 3 4 5 6 7 8 9 10

a o a .o rg.a u 307
Table ST60 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Prosthesis Combination (Primary
N N
Humeral Stem Glenoid Component 1 Yr 3 Yrs 5 Yrs 7 Yrs 9 Yrs 10 Yrs
Revised Total
Affinis Affinis 2 42 7.3 (1.7, 28.0)
Anatomical Shoulder Trabecular Metal 3 26 7.7 (2.0, 27.4)
Comprehensive Comprehensive Reverse 2 100 2.1 (0.5, 8.1) 2.1 (0.5, 8.1)
RSP RSP 3 172 2.5 (0.8, 7.7)
SMR SMR L1 58 1206 4.1 (3.1, 5.4) 5.1 (3.9, 6.7) 7.4 (5.2, 10.3) 7.4 (5.2, 10.3)
SMR SMR L2 21 381 3.7 (2.2, 6.2) 4.8 (3.0, 7.5) 5.8 (3.8, 8.8)
Other (12) 2 60 1.7 (0.2, 11.2) 1.7 (0.2, 11.2) 1.7 (0.2, 11.2) 1.7 (0.2, 11.2) 8.7 (1.8, 37.4)
TOTAL 207 5363
Combination (Primary Diagnosis Rotator Cuff Arthropathy)
N N
Revised Total
Affinis Affinis 2 35 8.6 (2.0, 32.3)
Comprehensive Comprehensive Reverse 2 99 2.1 (0.5, 8.1) 2.1 (0.5, 8.1)
SMR SMR L1 53 1166 3.8 (2.8, 5.1) 4.8 (3.6, 6.3) 7.1 (4.9, 10.1) 7.1 (4.9, 10.1)
SMR SMR L2 21 373 3.8 (2.2, 6.3) 4.9 (3.1, 7.6) 5.9 (3.9, 8.9)
Other (14) 5 83 5.1 (1.9, 13.0) 5.1 (1.9, 13.0) 5.1 (1.9, 13.0) 5.1 (1.9, 13.0)
TOTAL 184 4608
Prosthesis Combination (Primary Diagnosis Rotator Cuff Arthropathy)
Glenoid N N
Aequalis Aequalis 7 134 2.5 (0.8, 7.5) 5.3 (2.4, 11.5)
Delta Xtend Delta Xtend 7 327 1.5 (0.6, 3.7) 1.9 (0.9, 4.2) 2.6 (1.2, 5.8)
RSP RSP 2 150 1.9 (0.4, 7.5)
SMR SMR L1 4 29 11.6 (3.9, 32.0) 16.8 (6.6, 39.4) 16.8 (6.6, 39.4) 16.8 (6.6, 39.4)
Other (8) 1 38 0.0 (0.0, 0.0) 3.4 (0.5, 22.1) 3.4 (0.5, 22.1)
TOTAL 22 706

OUTCOME FOR FRACTURE

For the diagnosis of fracture, patients aged 55 Glenosphere sizes larger than 40mm have a
to 64 years have a higher rate of revision higher rate of revision. This is in contrast to
compared to those aged 75 years or older osteoarthritis (Table ST67 and Figure ST43).
Males have a higher rate of revision than Glenosphere sizes larger than 40mm have a
females over the entire period (Table ST64 and higher rate of revision.
Figure ST40).
Fixation
The reasons for revision and cumulative
Cementless fixation has a higher rate of incidence revision diagnoses are shown in
revision for fracture than hybrid (humerus Table ST68 and Figure ST44. The larger
cemented) fixation (Table ST65 and Figure glenospheres have a higher cumulative
ST41). A similar result was observed when the incidence of revision for instability/dislocation.
SMR L2 prosthesis was excluded (Table ST66
and Figure ST42). The outcomes of the most commonly used
prosthesis combinations are listed in Table ST69.
The cementless prosthesis combinations used in
total reverse shoulder replacement for fracture
are listed in Table ST70. The hybrid (humerus
cemented) prosthesis combinations used in
total reverse shoulder replacement for fracture
are listed in Table ST71.

a o a .o rg.a u 309
Table ST63 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Age (Primary Diagnosis Fracture)
N N
Revised Total
<55 2 21 9.8 (2.5, 33.8) 9.8 (2.5, 33.8)
55-64 16 207 6.0 (3.4, 10.3) 8.4 (5.1, 13.8)
65-74 31 775 3.0 (2.0, 4.5) 4.4 (3.0, 6.4) 5.8 (3.9, 8.6)
≥75 31 1362 2.1 (1.4, 3.1) 2.2 (1.5, 3.2) 2.6 (1.7, 3.9) 3.8 (2.3, 6.5)
TOTAL 80 2365
Figure ST39 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Age (Primary Diagnosis Fracture)

30%
55-64
55-64 vs ≥75
65-74
≥75 Entire Period: HR=2.91 (1.59, 5.35),p<0.001
25%
65-74 vs ≥75
20%
55-64 vs 65-74
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

55-64 207 141 80 38 18 2 0
65-74 775 561 266 104 37 8 1
≥75 1362 1003 524 217 65 10 1

Table ST64 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Gender (Primary Diagnosis
Fracture)
N N
Revised Total
Male 31 355 7.9 (5.5, 11.3) 9.5 (6.6, 13.4) 10.3 (7.2, 14.6)
Female 49 2010 1.9 (1.4, 2.6) 2.5 (1.8, 3.4) 3.3 (2.4, 4.5) 4.1 (2.8, 5.9)
TOTAL 80 2365
Figure ST40 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Gender (Primary Diagnosis
Fracture)

30%
Male
Male vs Female
Female
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Male 355 240 119 41 16 3 0
Female 2010 1481 758 321 106 17 2

a o a .o rg.a u 311
Table ST65 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis
Fracture)
N N
Revised Total
Cemented 3 35 9.4 (3.1, 26.3) 9.4 (3.1, 26.3) 9.4 (3.1, 26.3)
Cementless 48 940 4.0 (2.9, 5.5) 5.1 (3.7, 6.9) 6.4 (4.7, 8.8) 7.9 (5.5, 11.3)
TOTAL 80 2365
Figure ST41 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis
Fracture)

30%
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Cementless 940 677 385 172 61 12 1

Table ST66 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis
Fracture, excluding SMR L2)
N N
Revised Total
Cemented 3 33 10.0 (3.3, 27.9) 10.0 (3.3, 27.9) 10.0 (3.3, 27.9)
Cementless 38 792 4.2 (2.9, 5.9) 5.0 (3.6, 6.9) 5.9 (3.9, 9.0) 8.4 (5.1, 13.7)
TOTAL 69 2167
Figure ST42 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis
Fracture, excluding SMR L2)

30%
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

Cementless 792 536 257 87 60 12 1

a o a .o rg.a u 313
Diagnosis Fracture)
N N
Revised Total
<38mm 31 1142 2.1 (1.4, 3.1) 2.9 (2.0, 4.2) 3.5 (2.4, 5.2) 3.5 (2.4, 5.2)
38-40mm 23 886 2.3 (1.5, 3.5) 2.8 (1.8, 4.5) 3.4 (2.1, 5.6)
>40mm 26 331 6.8 (4.5, 10.2) 7.7 (5.2, 11.5)
TOTAL 80 2359
Note: Excludes six procedures with unknown glenosphere size
Diagnosis Fracture)

30%
<38mm
<38mm vs 38-40mm
38-40mm
25%
>40mm vs 38-40mm
20%
>40mm vs <38mm
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

<38mm 1142 861 484 226 83 14 2
38-40mm 886 628 271 101 33 3 0
>40mm 331 226 119 34 6 3 0

Table ST68 Revision Diagnosis of Primary Total Reverse Shoulder Replacement by Glenosphere Size (Primary Diagnosis
Fracture)
<38mm 38-40mm >40mm

% % %
% % %
Revision Diagnosis Number Primaries Number Primaries Number Primaries
Revisions Revisions Revisions
Revised Revised Revised
Instability/Dislocation 14 1.2 45.2 12 1.4 52.2 13 3.9 50.0
Infection 9 0.8 29.0 2 0.2 8.7 2 0.6 7.7
Fracture 3 0.3 9.7 6 0.7 26.1 6 1.8 23.1
Loosening 3 0.3 9.7 1 0.1 4.3 3 0.9 11.5
Arthrofibrosis 1 0.1 3.2
Implant Breakage Glenoid 1 0.3 3.8
Malposition 1 0.1 4.3
Pain 1 0.1 3.2 1 0.3 3.8
Other 1 0.1 4.3
N Revision 31 2.7 100.0 23 2.6 100.0 26 7.9 100.0
N Primary 1142 886 331
Note: Excludes six procedures with unknown glenosphere size

a o a .o rg.a u 315
<38mm 38-40mm
8.0% 8.0%
Fracture Fracture
7.0% 7.0%
Infection Infection
Loosening Loosening
6.0% Pain 6.0% Pain
5.0% 5.0%
4.0% 4.0%
3.0% 3.0%
2.0% 2.0%
1.0% 1.0%
0.0% 0.0%
0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10
>40mm
8.0%
Fracture
7.0%
Infection
Loosening
6.0% Pain
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
0 1 2 3 4 5 6 7 8 9 10

Table ST69 Cumulative Percent Revision of Primary Total Reverse Shoulder Replacement by Prosthesis Combination (Primary
Diagnosis Fracture)
N N
Revised Total
Aequalis Aequalis 9 370 2.0 (1.0, 4.2) 2.5 (1.2, 5.0) 4.2 (1.7, 10.4)
Comprehensive Comprehensive Reverse 0 85 0.0 (0.0, 0.0)
RSP RSP 4 67 3.1 (0.8, 11.7)
SMR SMR L1 32 648 4.6 (3.2, 6.6) 5.3 (3.7, 7.5) 5.3 (3.7, 7.5) 6.7 (4.1, 10.8)
SMR SMR L2 11 198 3.0 (1.4, 6.7) 4.2 (2.1, 8.2) 5.9 (3.3, 10.5)
Trabecular Metal Trabecular Metal 0 153 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Other (13) 2 143 1.4 (0.4, 5.6)
TOTAL 80 2365
Combination (Primary Diagnosis Fracture)
N N
Revised Total
Delta Xtend Delta Xtend 3 115 0.9 (0.1, 6.0) 2.3 (0.6, 9.5)
SMR SMR L1 31 544 5.3 (3.7, 7.6) 6.1 (4.3, 8.7) 6.1 (4.3, 8.7) 8.0 (4.7, 13.3)
SMR SMR L2 10 148 3.4 (1.4, 8.0) 4.9 (2.3, 9.9) 7.2 (3.9, 12.9)
Other (13) 4 133 2.3 (0.8, 7.0) 2.3 (0.8, 7.0)
TOTAL 48 940
Prosthesis Combination (Primary Diagnosis Fracture)
N N
Revised Total
Aequalis Aequalis 7 339 1.9 (0.8, 4.1) 2.4 (1.1, 5.1)
Comprehensive Comprehensive Reverse 0 68 0.0 (0.0, 0.0)
RSP RSP 3 57 1.8 (0.3, 12.2)
SMR SMR L1 0 97 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Trabecular Metal Trabecular Metal 0 104 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Other (12) 1 137 0.7 (0.1, 5.1) 0.7 (0.1, 5.1)
TOTAL 28 1370

a o a .o rg.a u 317
Prostheses with
Higher Than Anticipated
Rates of Revision
Prostheses with Higher Than

Anticipated Rates of Revision
INTRODUCTION
A unique and important function of registries is The Registry has the capacity to assess the
that they are able to provide population based outcome of individual prostheses or
data on the comparative outcome of combinations of prostheses used in a
individual prostheses in a community. Outcome procedure. It is apparent from previous reports
data are necessary to enable an evidence- that individual prostheses that perform well in
based approach to prosthesis selection. For one combination may not perform well in
many prostheses, the only source of outcome another. Therefore, the outcome of an
data are Registry reports. individual prosthesis is partly dependent on the
combination of the different prostheses used.
It is evident from Registry data that most
prostheses have similar outcomes. However, a Consequently, the Registry undertakes two
number have a rate of revision that is different analyses in Stage 1. The first assesses
statistically higher than other prostheses in the the outcome of all combinations. The second
same class. The Registry identifies these as assesses all individual prostheses regardless of
‘prostheses with a higher than anticipated rate the combination. Both analyses are reviewed to
of revision’. determine if a higher revision rate is identified
with a single combination, multiple
The Registry has developed a standardised combinations, or uniformly with all
three-stage approach to identify prostheses combinations. If prostheses are identified in a
that are outliers with respect to rate of revision. single combination, that combination
The comparator group includes all other progresses to Stage 2. An individual prosthesis
prostheses within the same class regardless of progresses to Stage 2 if it is identified in multiple
their rate of revision. This is a more pragmatic combinations or uniformly across all
approach than comparing to a select group of combinations.
prostheses with the lowest rate of revision.
If a prosthesis is identified in more than two
Stage 1 combinations with 10 or more procedures in
The first stage is a screening test to identify Stage 1, an additional analysis of the individual
prostheses that differ significantly from the prosthesis is undertaken for review at Stage 2,
combined revisions per 100 observed regardless of whether the individual prosthesis
component years of all other prostheses in the was identified in Stage 1. The purpose of this is
same class. It is an automated analysis that to simplify the reporting of an individual
identifies prostheses based on set criteria. These prosthesis and to avoid identifying the same
include: prosthesis in multiple combinations when it may
be more appropriate to identify it individually.
1. the revision rate (per 100 component
years) exceeds twice that for the group, A prosthesis or combination may also be
and brought to the attention of the Registry by the
2. the Poisson probability of observing that Therapeutic Goods Administration (TGA) or a
number of revisions, given the rate of member of the AOA. A further investigation
the group is significant (p<0.05), and may then be undertaken as outlined in Stage 2.
either:
Stage 2
3. there are at least 10 primary procedures In Stage 2, the AOANJRR Director and Deputy
for that component, Directors in conjunction with SAHMRI staff,
review the identified prostheses and undertake
or
further investigation. This includes examining the
4. the proportion revised is at least 75% impact of confounders and calculating age
and there have been at least two and gender adjusted hazard ratios. In addition,
revisions. all prostheses identified in previous reports are
re-analysed as part of the Stage 2 analysis. This

a o a .o rg.a u 319
is not dependent on re-identification in Stage 1. prostheses. Identification is made to ensure that

If there is a significant difference compared to prostheses with a higher rate of revision,
the combined hazard rate of all other compared to others in the same class, are
prostheses in the same class, then the prosthesis highlighted.
or prosthesis combination progresses to Stage 3.
The possible exception to this is the presence of On occasion, a prosthesis previously identified
confounding factors, such as use in complex no longer meets the criteria for inclusion. In this
primary procedures. situation, the prosthesis is not subsequently re-
identified. The Registry monitors the continual
Stage 3 real time performance of prostheses within a
The final stage involves review by a panel of community and the Annual Report provides a
independent orthopaedic surgeons from the snap shot at a particular time. It is necessary to
Australian Orthopaedic Association and appreciate that outcomes are continually
Arthroplasty Society. The panel meets with changing and that many factors may influence
Registry staff at a joint specific workshop to that change, including identification in the
review the Stage 2 analysis and determine report.
which prostheses will be identified in the Annual
Report. The current approach used by the Registry is
most effective at identifying the relative
performance of recently introduced prostheses.
IDENTIFIED PROSTHESES As the Registry’s follow up period increases, it is
Identified prostheses are listed in one of three becoming evident that prostheses with a
groups. The first group, ‘Newly Identified’, lists delayed onset of higher rates of revision are not
prostheses that are identified for the first time as readily identified by this approach. The
and are still used. Registry will develop further strategies in the
future to identify these prostheses.
The second group is ‘Re-identified and still
used’. This listing identifies prostheses which This year, 19 independent arthroplasty
continue to have a higher than anticipated specialists together with the Chairperson of the
rate of revision and provides information on AOANJRR Committee, AOANJRR Director, three
their continued use. Most identified or re- Deputy Directors, two assistant Deputy Directors
identified prostheses decline in use. This is and SAHMRI Registry staff attended the two
usually evident only after the first year because day Hip and Knee Surgeon Review Workshop.
almost a full year of use has occurred prior to
identification in the Annual Report. The Shoulder Chapter was reviewed at a
weekend workshop under the leadership of
Prostheses that have a higher rate of revision Professor Richard Page, together with the
but are no longer used in Australia make up the AOANJRR Director, one Deputy Director and
third group: ‘Identified and no longer used’. SAHMRI Registry staff.
These are listed to provide ongoing information
on the rate of revision. This also enables Only prostheses identified for the first time or
comparison of other prostheses to the prostheses that are not re-identified are
discontinued group. This group may include discussed in the following text.
prostheses that are no longer used in Australia
Investigations of prostheses identified as having a higher than
that are identified for the first time. anticipated rate of revision are available on the Registry website:
The Registry does not make a recommendation
or otherwise on the continued use of identified

PRIMARY PARTIAL HIP REPLACEMENT

UNIPOLAR MODULAR
There are no newly identified unipolar modular
prostheses.
Table IP1 Revision Rate of Individual Unipolar Modular Hip Prostheses Identified as having a Higher than Anticipated Rate of
Revision
N N Obs. Revisions/100
Head/Femoral Hazard Ratio, P Value
Revised Total Years Obs. Yrs
Re-Identified and Still Used . . . .
Unipolar Head (JRI)/Furlong LOL 10 131 358 2.79 Entire Period: HR=2.29 (1.23, 4.26),p=0.009
Note: All components have been compared to all other unipolar modular hip components
Table IP2 Cumulative Percent Revision of Individual Unipolar Modular Hip Prostheses Identified as having a Higher than
Anticipated Rate of Revision
CPR 1 Yr 3 Yrs 5 Yrs 10 Yrs 16 Yrs

Re-Identified and Still Used
Unipolar Head (JRI)/Furlong LOL 6.4 (3.1, 13.0) 9.9 (5.4, 17.7)
Table IP3 Yearly Usage of Individual Unipolar Modular Hip Prostheses Identified as having a Higher than Anticipated Rate of
Revision
Year of Implant ≤2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Re-Identified and Still Used . . . . . . . . . . . . . . .
Unipolar Head (JRI)/Furlong LOL . . . . . 12 18 10 13 10 8 7 34 16 3

a o a .o rg.a u 321
Figure IP1 Cumulative Percent Revision of Re-identified and still used Individual Unipolar Modular Hip Prostheses
Re-identified and still used
20%
Unipolar Head (JRI)/Furlong LOL
18% Other Unipolar Modular Hip
16%

14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

BIPOLAR
There are no newly identified bipolar hip
prostheses.
Table IP4 Revision Rate of Individual Bipolar Hip Prostheses Identified as having a Higher than Anticipated Rate of Revision
Bipolar/Femoral Hazard Ratio, P Value
Bipolar Head (Medacta)/Quadra-H 6 57 111 5.39 Entire Period: HR=4.28 (1.91, 9.57),p<0.001
Identified and no longer used . . . .
Tandem/Basis 13 114 438 2.97 Entire Period: HR=2.53 (1.46, 4.40),p<0.001
UHR/ABGII 20 177 897 2.23 Entire Period: HR=2.63 (1.68, 4.10),p<0.001
UHR/Omnifit (cless) 7 40 232 3.02 0 - 3Mth: HR=4.51 (1.44, 14.09),p=0.009
. . . . 3Mth - 6Mth: HR=8.98 (1.24, 65.01),p=0.029
. . . . 6Mth+: HR=2.21 (0.71, 6.88),p=0.172
**Synergy 9 54 358 2.51 Entire Period: HR=2.74 (1.42, 5.30),p=0.002
Note: All components have been compared to all other bipolar hip components
** Femoral Component
Table IP5 Cumulative Percent Revision of Individual Bipolar Hip Prostheses Identified as having a Higher than Anticipated Rate
of Revision

Bipolar Head (Medacta)/Quadra-H 8.9 (3.4, 22.2) 12.7 (5.3, 28.8)
Identified and no longer used
Tandem/Basis 2.0 (0.5, 7.7) 12.5 (7.1, 21.5)
UHR/ABGII 4.4 (2.1, 8.9) 5.1 (2.6, 10.1) 10.9 (6.5, 18.0)
UHR/Omnifit (cless) 18.3 (9.1, 34.6) 18.3 (9.1, 34.6) 18.3 (9.1, 34.6) 18.3 (9.1, 34.6)
**Synergy 7.5 (2.9, 18.7) 9.7 (4.1, 21.8) 12.3 (5.7, 25.7) 18.4 (9.4, 34.1)
Note: ** Femoral Component
Table IP6 Yearly Usage of Individual Bipolar Hip Prostheses Identified as having a Higher than Anticipated Rate of Revision
Year of Implant ≤2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Bipolar Head (Medacta)/Quadra-H . . . . . . . 10 7 5 6 3 11 8 7
Identified and no longer used . . . . . . . . . . . . . . .
Tandem/Basis . . . 10 13 9 11 4 7 8 21 24 6 1 .
UHR/ABGII 25 25 36 34 10 15 20 7 5 . . . . . .
UHR/Omnifit (cless) 11 10 7 5 4 1 2 . . . . . . . .
**Synergy 12 13 9 10 3 2 1 1 . 1 . 2 . . .
Note: ** Femoral Component

a o a .o rg.a u 323
Figure IP2 Cumulative Percent Revision of Re-identified and still used Individual Bipolar Hip Prostheses
60%
Bipolar Head (Medacta)/Quadra-H
Other Bipolar Hip
50%

40%
30%
20%
10%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

PRIMARY TOTAL HIP REPLACEMENT

TOTAL CONVENTIONAL
Large head metal/metal bearings have been Of the 20 revisions, five were femoral only, two
removed from the comparator group for all were acetabular only, and nine were
primary total conventional hip investigations. head/insert.
The Furlong femoral stem is no longer identified. The Taperloc/Versafitcup CC combination has
There have been an additional three been used in 75 procedures. Of the four
procedures and one further revision since the revisions, three were femoral only and one was
previous report. revision of the head only. The reasons for
revision were fracture (50.0%), infection (25.0%)
There are four primary total conventional hip and pain (25.0%).
combinations and one acetabular prosthesis
identified for the first time. The Delta-One-TT acetabular component has
been used in 95 procedures since 2010. The
The Quadra-H/Versafitcup DM combination has cumulative percent revision at three years was
been used in 283 procedures since 2012. The 7.3%. Of the six revisions, four were acetabular
cumulative percent revision at one year was only and two were femoral only. The reasons for
4.2%. Of the 10 revisions, four were femoral only, revision were loosening (50.0%), dislocation
two acetabular only and four were minor (33.3%) and fracture (16.7%).
revisions. The main reasons for revision were
fracture (30.0%), infection (30.0%) and The Hyperion/Delta-TT combination has been
loosening (20.0%). identified for the first time and is no longer used.
The Taperloc/G7 combination has been used in The Continuum acetabular component remains
911 procedures since 2013. The cumulative identified because of its higher than
percent revision at one year was 2.4%. This anticipated rate of revision in the first three
combination has a higher rate of revision in the months. However, after 2.5 years it has a lower
first two weeks only and after this time there is rate of revision than other total conventional
no difference when compared to other total hip prostheses.
conventional hip procedures. The main reasons
for revision were dislocation (50.0%), fracture
(20.0%), infection (15.0%) and loosening (10.0%).

a o a .o rg.a u 325
Table IP7 Revision Rate of Individual Total Conventional Hip Prostheses Identified as having a Higher than Anticipated Rate of
Revision
Femoral/Acetabular Hazard Ratio, P Value
Newly Identified . . . .
Quadra-H/Versafitcup DM 10 283 282 3.55 Entire Period: HR=2.20 (1.18, 4.08),p=0.012
Taperloc/G7 20 911 1084 1.85 0 - 2Wk: HR=3.15 (1.57, 6.31),p=0.001
. . . . 2Wk+: HR=0.91 (0.52, 1.61),p=0.754
Taperloc/Versafitcup CC 4 75 21 18.7 Entire Period: HR=5.78 (2.17, 15.40),p<0.001
**Delta-One-TT 6 95 232 2.58 Entire Period: HR=2.65 (1.19, 5.89),p=0.017
CPT/Fitmore 13 216 912 1.43 Entire Period: HR=2.06 (1.19, 3.54),p=0.009
CPT/Low Profile Cup 11 136 657 1.67 Entire Period: HR=2.59 (1.44, 4.67),p=0.001
Corail/Trabecular Metal (Shell) 11 90 399 2.76 Entire Period: HR=3.95 (2.19, 7.13),p<0.001
Metafix/Trinity 43 2147 4622 0.93 0 - 2Wk: HR=1.82 (1.00, 3.29),p=0.048
. . . . 2Wk - 1.5Yr: HR=0.90 (0.62, 1.31),p=0.582
. . . . 1.5Yr+: HR=0.44 (0.16, 1.16),p=0.097
Profemur L/Dynasty 22 770 999 2.20 Entire Period: HR=1.60 (1.05, 2.43),p=0.027
Taperloc Microplasty/Regenerex 4 48 201 1.99 Entire Period: HR=2.81 (1.06, 7.49),p=0.038
*Apex 126 2380 12838 0.98 Entire Period: HR=1.48 (1.24, 1.76),p<0.001
*Emperion 38 494 2350 1.62 Entire Period: HR=2.27 (1.65, 3.12),p<0.001
*Excia (cless) 20 285 1031 1.94 Entire Period: HR=2.57 (1.66, 3.99),p<0.001
*Furlong Evolution 6 91 187 3.21 Entire Period: HR=3.06 (1.37, 6.81),p=0.006
*ML Taper Kinectiv 133 3298 14208 0.94 Entire Period: HR=1.31 (1.10, 1.55),p=0.002
*Novation 35 996 2526 1.39 Entire Period: HR=1.49 (1.07, 2.08),p=0.017
*Taper Fit 50 915 3697 1.35 0 - 1Mth: HR=0.50 (0.16, 1.56),p=0.234
. . . . 1Mth - 3Mth: HR=1.35 (0.56, 3.26),p=0.498
. . . . 3Mth - 6Mth: HR=0.52 (0.07, 3.71),p=0.516
. . . . 6Mth+: HR=2.69 (1.98, 3.65),p<0.001
*Trabecular Metal 101 1866 8654 1.17 0 - 3Mth: HR=2.38 (1.80, 3.16),p<0.001
. . . . 3Mth+: HR=1.30 (0.99, 1.71),p=0.060
*UniSyn 45 462 3081 1.46 Entire Period: HR=2.33 (1.74, 3.12),p<0.001
**Continuum 322 9520 30945 1.04 0 - 3Mth: HR=1.72 (1.48, 2.00),p<0.001
. . . . 3Mth - 1.5Yr: HR=1.06 (0.84, 1.33),p=0.621
. . . . 1.5Yr - 2.5Yr: HR=1.30 (0.94, 1.80),p=0.109
. . . . 2.5Yr+: HR=0.67 (0.47, 0.96),p=0.028
**Furlong 30 568 2654 1.13 Entire Period: HR=1.61 (1.13, 2.30),p=0.009
**Plasmacup 30 482 2153 1.39 Entire Period: HR=1.96 (1.37, 2.80),p<0.001
**Procotyl L 52 1076 4426 1.17 Entire Period: HR=1.62 (1.24, 2.13),p<0.001
+Hyperion/Delta-TT 8 128 453 1.77 Entire Period: HR=2.24 (1.12, 4.48),p=0.022
Anatomic II/Duraloc Option 7 60 514 1.36 Entire Period: HR=2.35 (1.12, 4.92),p=0.023
Anca-Fit/Pinnacle 14 101 775 1.81 Entire Period: HR=3.14 (1.86, 5.30),p<0.001
F2L/Delta-PF 17 107 957 1.78 Entire Period: HR=3.07 (1.91, 4.93),p<0.001
Friendly Hip/Cup (Exactech) 14 97 853 1.64 Entire Period: HR=2.88 (1.71, 4.87),p<0.001
H Moos/Mueller 9 19 139 6.47 Entire Period: HR=10.39 (5.41, 19.95),p<0.001
Secur-Fit Plus/Secur-Fit 23 197 2100 1.10 Entire Period: HR=1.86 (1.23, 2.79),p=0.003
Taperloc/M2a MoM
59 515 4844 1.22 Entire Period: HR=2.08 (1.61, 2.69),p<0.001
*ABGII (exch neck) 70 246 1384 5.06 0 - 1Mth: HR=3.68 (1.65, 8.21),p=0.001
. . . . 1Mth - 2.5Yr: HR=3.45 (2.04, 5.82),p<0.001
. . . . 2.5Yr - 4Yr: HR=11.15 (6.46, 19.26),p<0.001
. . . . 4Yr - 4.5Yr: HR=32.93 (18.07, 60.01),p<0.001

. . . . 4.5Yr+: HR=17.04 (11.58, 25.10),p<0.001
*Adapter (cless) 115 744 5088 2.26 0 - 2Wk: HR=3.88 (1.93, 7.78),p<0.001
. . . . 2Wk - 1Mth: HR=1.73 (0.72, 4.16),p=0.222
. . . . 1Mth - 6Mth: HR=0.82 (0.31, 2.18),p=0.687
. . . . 6Mth - 3Yr: HR=3.59 (2.53, 5.08),p<0.001
. . . . 3Yr - 3.5Yr: HR=9.86 (5.56, 17.48),p<0.001
. . . . 3.5Yr+: HR=5.06 (3.87, 6.63),p<0.001
*Adapter (ctd) 30 148 987 3.04 0 - 6Mth: HR=2.19 (0.82, 5.83),p=0.118
. . . . 6Mth+: HR=5.29 (3.60, 7.76),p<0.001
*BMHR VST 21 260 1482 1.42 Entire Period: HR=2.02 (1.32, 3.10),p=0.001
*CBH Stem 35 274 1634 2.14 Entire Period: HR=3.40 (2.44, 4.73),p<0.001
*Edinburgh 18 138 842 2.14 Entire Period: HR=3.61 (2.27, 5.72),p<0.001
*Elite Plus 235 2841 27751 0.85 0 - 1Mth: HR=0.27 (0.11, 0.65),p=0.003
. . . . 1Mth - 9Mth: HR=1.02 (0.68, 1.53),p=0.916
. . . . 9Mth+: HR=1.77 (1.54, 2.03),p<0.001
*K2 67 601 3624 1.85 Entire Period: HR=2.96 (2.33, 3.77),p<0.001
*LYDERIC II 15 164 1306 1.15 Entire Period: HR=2.00 (1.20, 3.31),p=0.007
*MSA 23 224 1092 2.11 Entire Period: HR=2.94 (1.95, 4.43),p<0.001
*Margron 102 688 7024 1.45 0 - 3Mth: HR=2.35 (1.48, 3.74),p<0.001
. . . . 3Mth - 1Yr: HR=5.70 (3.74, 8.67),p<0.001
. . . . 1Yr - 2Yr: HR=2.37 (1.18, 4.74),p=0.015
. . . . 2Yr - 4Yr: HR=2.96 (1.75, 5.01),p<0.001
. . . . 4Yr - 7Yr: HR=4.10 (2.80, 5.99),p<0.001
. . . . 7Yr+: HR=0.84 (0.49, 1.45),p=0.528
*Mayo 16 168 1446 1.11 Entire Period: HR=1.91 (1.17, 3.12),p=0.009
*Metha (exch neck) 13 88 488 2.67 Entire Period: HR=4.01 (2.33, 6.91),p<0.001
*Profemur Z 26 186 1636 1.59 Entire Period: HR=2.74 (1.86, 4.02),p<0.001
**2000 Plus 16 135 971 1.65 Entire Period: HR=2.78 (1.70, 4.54),p<0.001
**ASR 1801 4421 31051 5.80 0 - 1.5Yr: HR=1.47 (1.24, 1.75),p<0.001
. . . . 1.5Yr - 2Yr: HR=6.26 (4.83, 8.10),p<0.001
. . . . 2Yr - 3Yr: HR=13.09 (11.32, 15.13),p<0.001
. . . . 3Yr - 5Yr: HR=23.69 (21.57, 26.02),p<0.001
. . . . 5Yr - 5.5Yr: HR=27.93 (23.32, 33.45),p<0.001
. . . . 5.5Yr - 6Yr: HR=23.26 (18.98, 28.50),p<0.001
. . . . 6Yr - 7Yr: HR=17.28 (14.57, 20.50),p<0.001
. . . . 7Yr - 8.5Yr: HR=13.60 (11.56, 15.99),p<0.001
. . . . 8.5Yr+: HR=6.84 (5.56, 8.43),p<0.001
**Adept 17 121 856 1.99 Entire Period: HR=3.18 (1.97, 5.11),p<0.001
**Artek 63 179 2016 3.13 0 - 1.5Yr: HR=1.93 (0.92, 4.04),p=0.083
. . . . 1.5Yr+: HR=6.32 (4.85, 8.22),p<0.001
**BHR 347 2987 23928 1.45 0 - 2Wk: HR=0.81 (0.39, 1.71),p=0.584
. . . . 2Wk - 1Mth: HR=0.17 (0.04, 0.66),p=0.010
. . . . 1Mth - 1.5Yr: HR=0.93 (0.67, 1.29),p=0.664
. . . . 1.5Yr+: HR=3.60 (3.21, 4.05),p<0.001
**Bionik 117 608 4290 2.73 0 - 3Mth: HR=1.66 (0.92, 2.99),p=0.094
. . . . 3Mth+: HR=5.59 (4.62, 6.77),p<0.001
**Cormet 96 803 6557 1.46 0 - 1.5Yr: HR=1.05 (0.65, 1.69),p=0.845
. . . . 1.5Yr - 2Yr: HR=0.53 (0.08, 3.80),p=0.531
. . . . 2Yr+: HR=3.68 (2.94, 4.61),p<0.001
**DeltaLox 22 222 965 2.28 Entire Period: HR=3.27 (2.15, 4.97),p<0.001

a o a .o rg.a u 327
**Duraloc 500 5354 52320 0.96 0 - 3Mth: HR=0.84 (0.63, 1.11),p=0.227
. . . . 3Mth - 9Mth: HR=1.36 (0.95, 1.95),p=0.096
. . . . 9Mth - 2Yr: HR=1.58 (1.20, 2.07),p<0.001
. . . . 2Yr - 2.5Yr: HR=0.76 (0.38, 1.53),p=0.445
. . . . 2.5Yr - 3Yr: HR=1.80 (1.11, 2.92),p=0.017
. . . . 3Yr - 5.5Yr: HR=1.47 (1.14, 1.89),p=0.002
. . . . 5.5Yr+: HR=2.35 (2.08, 2.66),p<0.001
**Durom 148 1245 10842 1.37 0 - 1.5Yr: HR=0.75 (0.48, 1.17),p=0.204
. . . . 1.5Yr+: HR=3.29 (2.76, 3.92),p<0.001
**ExpanSys 11 71 636 1.73 Entire Period: HR=3.02 (1.67, 5.46),p<0.001
**Fin II 110 2025 11808 0.93 Entire Period: HR=1.47 (1.22, 1.77),p<0.001
**Hedrocel 9 46 489 1.84 Entire Period: HR=3.04 (1.58, 5.84),p<0.001
**Icon 75 401 2911 2.58 0 - 2.5Yr: HR=2.50 (1.68, 3.73),p<0.001
. . . . 2.5Yr+: HR=6.17 (4.68, 8.13),p<0.001
**Inter-Op 9 33 334 2.70 Entire Period: HR=4.57 (2.38, 8.79),p<0.001
**MBA 17 124 1008 1.69 Entire Period: HR=2.91 (1.81, 4.69),p<0.001
**Mitch TRH 86 732 5457 1.58 0 - 3Mth: HR=0.61 (0.25, 1.46),p=0.262
. . . . 3Mth+: HR=3.30 (2.65, 4.11),p<0.001
**SPH-Blind 107 952 10266 1.04 0 - 1Mth: HR=2.51 (1.54, 4.10),p<0.001
. . . . 1Mth+: HR=1.68 (1.37, 2.07),p<0.001
**seleXys (excluding seleXys PC) 42 391 2050 2.05 Entire Period: HR=3.08 (2.28, 4.17),p<0.001
Note: All components have been compared to all other total conventional hip components, excluding metal/metal bearings with head size
larger than 32mm
* Femoral Component, ** Acetabular Component
+ Newly identified and no longer used
Table IP8 Cumulative Percent Revision of Individual Total Conventional Hip Prostheses Identified as having a Higher than

Newly Identified
Quadra-H/Versafitcup DM 4.2 (2.2, 7.9)
Taperloc/G7 2.4 (1.5, 3.7)
Taperloc/Versafitcup CC
**Delta-One-TT 3.2 (1.0, 9.6) 7.3 (3.3, 15.8)
CPT/Fitmore 4.3 (2.3, 8.1) 4.9 (2.6, 8.9) 6.1 (3.3, 11.3)
CPT/Low Profile Cup 4.5 (2.0, 9.7) 6.1 (3.1, 11.9) 9.3 (5.2, 16.3)
Corail/Trabecular Metal (Shell) 6.7 (3.1, 14.3) 10.7 (5.7, 19.6) 13.9 (7.8, 23.8)
Metafix/Trinity 1.9 (1.4, 2.6) 2.4 (1.8, 3.2) 2.4 (1.8, 3.2)
Profemur L/Dynasty 3.1 (2.0, 4.7)
Taperloc Microplasty/Regenerex 8.5 (3.3, 21.1) 8.5 (3.3, 21.1) 8.5 (3.3, 21.1)
*Apex 2.3 (1.8, 3.0) 3.4 (2.7, 4.2) 5.0 (4.1, 6.1) 8.1 (6.6, 9.8)
*Emperion 4.7 (3.2, 7.0) 5.7 (3.9, 8.2) 7.3 (5.2, 10.2)
*Excia (cless) 5.0 (3.0, 8.3) 6.9 (4.4, 10.7) 7.6 (4.9, 11.8)
*Furlong Evolution 4.5 (1.7, 11.6) 7.3 (3.3, 15.5)
*ML Taper Kinectiv 2.2 (1.7, 2.8) 3.5 (2.9, 4.2) 4.5 (3.8, 5.4)
*Novation 2.8 (1.9, 4.0) 3.9 (2.8, 5.5) 4.4 (3.0, 6.4)
*Taper Fit 1.5 (0.9, 2.6) 3.0 (2.0, 4.7) 6.4 (4.4, 9.2) 13.0 (9.6, 17.5)
*Trabecular Metal 3.4 (2.7, 4.3) 4.8 (3.9, 5.9) 5.4 (4.5, 6.6)


*UniSyn 3.3 (2.0, 5.4) 5.9 (4.1, 8.6) 6.8 (4.8, 9.7) 13.1 (9.6, 17.7)
**Continuum 2.5 (2.2, 2.9) 3.4 (3.1, 3.8) 3.9 (3.5, 4.4)
**Furlong 3.4 (2.2, 5.2) 5.1 (3.6, 7.4) 5.5 (3.8, 7.9)
**Plasmacup 4.4 (2.9, 6.7) 5.8 (4.0, 8.4) 6.2 (4.3, 8.9)
**Procotyl L 3.4 (2.4, 4.7) 4.7 (3.6, 6.3) 5.3 (4.1, 7.0)
+Hyperion/Delta-TT 3.2 (1.2, 8.2) 5.6 (2.7, 11.3)
Anatomic II/Duraloc Option 1.7 (0.2, 11.2) 6.7 (2.6, 16.8) 10.1 (4.7, 21.1) 12.1 (6.0, 23.9)
Anca-Fit/Pinnacle 6.0 (2.7, 12.8) 8.0 (4.1, 15.3) 11.0 (6.3, 19.1)
F2L/Delta-PF 5.6 (2.6, 12.1) 10.3 (5.9, 17.9) 12.3 (7.3, 20.2) 15.5 (9.8, 24.0)
Friendly Hip/Cup (Exactech) 2.1 (0.5, 8.0) 3.2 (1.0, 9.5) 6.5 (3.0, 14.0) 14.2 (8.3, 23.8)
H Moos/Mueller 5.6 (0.8, 33.4) 33.3 (16.6, 59.6) 38.9 (20.8, 64.7) 46.5 (26.2, 72.4)
Secur-Fit Plus/Secur-Fit 3.1 (1.4, 6.7) 7.3 (4.4, 11.9) 7.8 (4.8, 12.6) 10.1 (6.5, 15.3)
Taperloc/M2aMoM 1.8 (0.9, 3.3) 4.3 (2.9, 6.5) 7.4 (5.4, 10.0) 12.3 (9.6, 15.8)
*ABGII (exch neck) 4.1 (2.2, 7.5) 10.3 (7.1, 14.9) 19.7 (15.2, 25.3)
*Adapter (cless) 3.2 (2.2, 4.8) 6.7 (5.1, 8.8) 11.4 (9.3, 14.0) 17.9 (15.0, 21.2)
*Adapter (ctd) 4.1 (1.9, 8.9) 9.1 (5.4, 15.2) 17.0 (11.6, 24.5)
*BMHR VST 1.9 (0.8, 4.6) 4.6 (2.7, 8.0) 6.8 (4.3, 10.8)
*CBH Stem 4.0 (2.3, 7.2) 7.5 (4.9, 11.3) 10.0 (6.9, 14.4)
*Edinburgh 6.0 (3.1, 11.7) 9.6 (5.6, 16.4) 12.5 (7.7, 20.0)
*Elite Plus 1.5 (1.1, 2.0) 2.8 (2.3, 3.5) 4.2 (3.5, 5.1) 7.6 (6.6, 8.8) 13.2 (11.3, 15.4)
*K2 5.2 (3.7, 7.3) 7.5 (5.7, 10.0) 9.8 (7.7, 12.6)
*LYDERIC II 3.1 (1.3, 7.2) 5.7 (3.0, 10.6) 7.1 (4.0, 12.5) 12.3 (7.3, 20.5)
*MSA 5.8 (3.4, 9.8) 9.0 (5.9, 13.6) 10.6 (7.1, 15.5)
*Margron 5.8 (4.3, 7.9) 8.4 (6.5, 10.8) 10.2 (8.2, 12.8) 14.9 (12.4, 17.9)
*Mayo 3.0 (1.3, 7.0) 6.6 (3.7, 11.6) 6.6 (3.7, 11.6) 9.0 (5.4, 14.9)
*Metha (exch neck) 12.5 (7.1, 21.4) 13.6 (8.0, 22.8) 13.6 (8.0, 22.8)
*Profemur Z 6.0 (3.4, 10.5) 10.4 (6.7, 15.8) 10.9 (7.2, 16.4) 12.2 (8.2, 18.0)
**2000 Plus 3.0 (1.1, 7.8) 6.8 (3.6, 12.7) 9.2 (5.3, 15.7)
**ASR 1.9 (1.5, 2.3) 9.6 (8.7, 10.5) 24.2 (23.0, 25.6) 44.8 (43.1, 46.4)
**Adept 4.1 (1.7, 9.6) 8.4 (4.6, 15.0) 9.3 (5.3, 16.2)
**Artek 2.8 (1.2, 6.7) 8.0 (4.8, 13.1) 15.6 (11.0, 21.9) 24.7 (18.9, 32.0)
**BHR 1.1 (0.8, 1.6) 3.2 (2.6, 3.9) 6.1 (5.2, 7.0) 14.1 (12.6, 15.6)
**Bionik 3.6 (2.4, 5.5) 7.6 (5.7, 10.0) 14.1 (11.5, 17.3) 21.5 (18.2, 25.3)
**Cormet 1.4 (0.8, 2.5) 3.4 (2.3, 4.9) 5.1 (3.7, 6.9) 15.4 (12.4, 19.0)
**DeltaLox 5.9 (3.5, 9.9) 8.7 (5.6, 13.3) 9.8 (6.5, 14.7)
**Duraloc 1.8 (1.5, 2.2) 3.0 (2.6, 3.5) 4.1 (3.6, 4.6) 8.5 (7.7, 9.4) 16.0 (13.9, 18.5)
**Durom 1.1 (0.7, 1.9) 3.6 (2.7, 4.8) 5.5 (4.3, 6.9) 12.7 (10.8, 14.9)
**ExpanSys 2.8 (0.7, 10.8) 5.7 (2.2, 14.4) 10.2 (5.0, 20.2) 16.6 (9.6, 28.1)
**Fin II 2.7 (2.1, 3.5) 3.6 (2.9, 4.5) 4.8 (3.9, 5.9) 7.2 (5.8, 9.0)
**Hedrocel 4.3 (1.1, 16.3) 6.6 (2.2, 19.2) 6.6 (2.2, 19.2) 20.4 (10.7, 37.0)
**Icon 3.0 (1.7, 5.3) 7.8 (5.5, 10.9) 12.7 (9.7, 16.4) 23.6 (18.8, 29.3)
**Inter-Op 12.1 (4.7, 29.1) 15.2 (6.6, 32.6) 21.4 (10.8, 39.8) 28.3 (15.8, 47.4)
**MBA 4.0 (1.7, 9.4) 8.2 (4.5, 14.8) 10.2 (5.9, 17.2) 16.0 (9.9, 25.4)
**Mitch TRH 1.5 (0.8, 2.7) 4.6 (3.3, 6.4) 7.4 (5.7, 9.6)
**SPH-Blind 3.8 (2.8, 5.2) 5.8 (4.5, 7.5) 7.3 (5.8, 9.2) 10.3 (8.5, 12.4)
**seleXys (excluding seleXys PC) 4.6 (2.9, 7.2) 7.8 (5.5, 11.0) 11.1 (8.2, 14.9)
Note: * Femoral Component, **Acetabular Component


a o a .o rg.a u 329
Table IP9 Yearly Usage of Individual Total Conventional Hip Prostheses Identified as having a Higher than Anticipated Rate of
Revision
Year of Implant ≤2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Newly Identified . . . . . . . . . . . . . . .
Quadra-H/Versafitcup DM . . . . . . . . . . 1 1 15 120 146
Taperloc/G7 . . . . . . . . . . . 19 147 333 412
Taperloc/Versafitcup CC . . . . . . . . . . 2 . . . 73
**Delta-One-TT . . . . . . . . 4 7 7 15 37 13 12
CPT/Fitmore . . 19 6 6 4 16 12 15 24 14 30 30 22 18
CPT/Low Profile Cup . . 15 9 8 7 7 6 9 16 26 20 6 5 2
Corail/Trabecular Metal (Shell) . . . . . 5 10 17 21 8 8 8 6 1 6
Metafix/Trinity . . . . . . . . 52 114 224 293 360 470 634
Profemur L/Dynasty . . . . . . . . . . . 23 172 280 295
Taperloc Microplasty/Regenerex . . . . . . . . 12 14 12 2 3 3 2
*Apex . . . 75 247 223 265 197 169 190 219 246 188 193 168
*Emperion . . . 1 13 21 26 65 87 72 44 53 38 41 33
*Excia (cless) . . . . . . 6 34 8 47 58 38 17 42 35
*Furlong Evolution . . . . . . . . . . . 29 23 29 10
*ML Taper Kinectiv . . . . . . 36 341 647 576 515 384 345 256 198
*Novation . . . . . . . 4 32 53 130 137 227 265 148
*Taper Fit 30 34 65 50 66 26 18 6 8 17 55 45 110 161 224
*Trabecular Metal . . . . 6 101 147 198 242 272 276 186 220 112 106
*UniSyn 1 14 41 74 33 37 46 48 36 23 19 23 27 23 17
**Continuum . . . . . . . 175 1117 1245 1333 1502 1492 1359 1297
**Furlong 27 4 . . . 4 7 61 90 84 73 76 64 66 12
**Plasmacup . . . 10 16 13 7 54 60 59 77 70 44 51 21
**Procotyl L . . . . . . 8 32 268 342 67 26 121 103 109
+Hyperion/Delta-TT . . . . . . . . 2 7 44 60 15 . .
Anatomic II/Duraloc Option . . . 4 33 23 . . . . . . . . .
Anca-Fit/Pinnacle . . . . 30 55 16 . . . . . . . .
F2L/Delta-PF . . 7 62 28 10 . . . . . . . . .
Friendly Hip/Cup (Exactech) 8 16 18 16 19 12 2 6 . . . . . . .
H Moos/Mueller 19 . . . . . . . . . . . . . .
Secur-Fit Plus/Secur-Fit 101 27 21 26 22 . . . . . . . . . .
Taperloc/M2aMoM 18 79 113 74 38 43 76 49 23 2 . . . . .
*ABGII (exch neck) . . . . . 10 39 69 58 63 7 . . . .
*Adapter (cless) . . . 19 140 131 122 158 113 60 . 1 . . .
*Adapter (ctd) . . . 7 41 52 33 8 7 . . . . . .
*BMHR VST . . . . . . 2 65 81 71 22 13 5 1 .
*CBH Stem . . 12 7 14 37 28 27 45 53 43 7 . 1 .
*Edinburgh . . . 20 37 29 18 23 10 1 . . . . .
*Elite Plus 1609 445 353 249 112 46 26 . . 1 . . . . .
*K2 . . . . 1 22 80 172 204 122 . . . . .
*LYDERIC II 33 16 64 23 12 8 8 . . . . . . . .
*MSA . . . . . 2 3 11 58 76 46 21 7 . .
*Margron 214 123 140 96 85 28 2 . . . . . . . .
*Mayo 10 11 14 23 24 25 29 30 2 . . . . . .
*Metha (exch neck) . . . . . . . 20 53 15 . . . . .
*Profemur Z . . 41 79 56 6 1 2 1 . . . . . .
**2000 Plus . . . 11 23 42 14 18 25 2 . . . . .

Year of Implant ≤2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
**ASR . . 84 584 958 1186 1179 430 . . . . . . .
**Adept . . . . 19 20 29 30 11 12 . . . . .
**Artek 179 . . . . . . . . . . . . . .
**BHR 39 66 127 288 550 581 476 404 276 134 27 13 5 1 .
**Bionik . . . 11 147 136 138 134 38 4 . . . . .
**Cormet 9 53 74 103 114 73 129 124 93 26 4 1 . . .
**DeltaLox . . . . . . . . 32 86 72 24 8 . .
**Duraloc 2147 907 631 448 301 253 293 187 82 84 18 3 . . .
**Durom . 5 79 265 322 257 218 85 13 1 . . . . .
**ExpanSys . 1 7 24 30 8 1 . . . . . . . .
**Fin II . . . 39 128 175 251 269 318 287 205 247 100 6 .
**Hedrocel 37 9 . . . . . . . . . . . . .
**Icon . . 3 40 80 84 68 78 37 11 . . . . .
**Inter-Op 33 . . . . . . . . . . . . . .
**MBA 49 29 19 11 9 5 2 . . . . . . . .
**Mitch TRH . . . . 45 274 164 130 82 37 . . . . .
**SPH-Blind 377 261 205 41 49 19 . . . . . . . . .
**seleXys (excluding seleXys PC) . . . . 35 33 20 21 53 70 89 57 13 . .


a o a .o rg.a u 331
Figure IP3 Cumulative Percent Revision of Newly Identified Individual Total Conventional Hip Prostheses
Newly Identified
30% 30%
Quadra-H/Versafitcup DM Taperloc/G7
Other Total Conventional Hip Other Total Conventional Hip
25% 25%

20% 20%
15% 15%
10% 10%
5% 5%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
30% 30%
Taperloc/Versafitcup CC **Delta-One-TT
25% 25%
20% 20%
15% 15%
10% 10%
5% 5%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Figure IP4 Cumulative Percent Revision of Re-identified and still used Individual Total Conventional Hip Prostheses
30% 30%
CPT/Fitmore CPT/Low Profile Cup
25% 25%

20% 20%
15% 15%
10% 10%
5% 5%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
30% 30%
Corail/Trabecular Metal (Shell) Metafix/Trinity
25% 25%
20% 20%
15% 15%
10% 10%
5% 5%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
30% 30%
Profemur L/Dynasty Taperloc Microplasty/Regenerex
25% 25%
20% 20%
15% 15%
10% 10%
5% 5%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

a o a .o rg.a u 333
30% 30%
*Apex *Emperion
25% 25%

20% 20%
15% 15%
10% 10%
5% 5%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
30% 30%
*Excia (cless) *Furlong Evolution
25% 25%
20% 20%
15% 15%
10% 10%
5% 5%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
30% 30%
*ML Taper Kinectiv *Novation
25% 25%
20% 20%
15% 15%
10% 10%
5% 5%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

30% 30%
*Taper Fit *Trabecular Metal
25% 25%

20% 20%
15% 15%
10% 10%
5% 5%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
30% 30%
*UniSyn **Continuum
25% 25%
20% 20%
15% 15%
10% 10%
5% 5%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
30% 30%
**Furlong **Plasmacup
25% 25%
20% 20%
15% 15%
10% 10%
5% 5%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

a o a .o rg.a u 335
30%
**Procotyl L
Other Total Conventional Hip
25%

20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

TOTAL RESURFACING
There are no newly identified total resurfacing
hip prostheses.
Table IP10 Revision Rate of Individual Total Resurfacing Hip Prostheses Identified as having a Higher than Anticipated Rate of
Revision
Head/Acetabular Hazard Ratio, P Value
ASR/ASR 356 1168 10182 3.50 0 - 3Mth: HR=1.78 (1.08, 2.92),p=0.022
. . . . 3Mth - 6Mth: HR=2.21 (1.19, 4.09),p=0.011
. . . . 6Mth - 4Yr: HR=3.03 (2.40, 3.82),p<0.001
. . . . 4Yr - 4.5Yr: HR=6.74 (4.25, 10.69),p<0.001
. . . . 4.5Yr - 5Yr: HR=8.99 (5.66, 14.26),p<0.001
. . . . 5Yr - 6Yr: HR=6.29 (4.42, 8.96),p<0.001
. . . . 6Yr - 9.5Yr: HR=4.71 (3.75, 5.90),p<0.001
. . . . 9.5Yr+: HR=3.69 (2.49, 5.46),p<0.001
Bionik/Bionik 47 200 1480 3.18 Entire Period: HR=3.33 (2.49, 4.46),p<0.001
Cormet/Cormet 113 626 5578 2.03 Entire Period: HR=1.95 (1.61, 2.37),p<0.001
Durom/Durom 93 847 8219 1.13 0 - 4.5Yr: HR=1.72 (1.32, 2.23),p<0.001
. . . . 4.5Yr+: HR=0.73 (0.51, 1.04),p=0.082
Recap/Recap 27 195 1585 1.70 Entire Period: HR=1.73 (1.18, 2.54),p=0.004
*Cormet 2000 HAP 23 95 1068 2.15 Entire Period: HR=2.33 (1.55, 3.52),p<0.001
Note: Components have been compared to all other total resurfacing hip components
* Head Component

a o a .o rg.a u 337
Table IP11 Cumulative Percent Revision of Individual Total Resurfacing Hip Prostheses Identified as having a Higher than

ASR/ASR 3.4 (2.5, 4.6) 7.2 (5.9, 8.8) 15.3 (13.4, 17.5) 30.4 (27.8, 33.3)
Bionik/Bionik 3.5 (1.7, 7.2) 12.0 (8.2, 17.4) 17.1 (12.5, 23.1)
Cormet/Cormet 2.1 (1.2, 3.6) 5.6 (4.1, 7.7) 9.5 (7.5, 12.1) 17.7 (14.7, 21.3)
Durom/Durom 3.2 (2.2, 4.6) 5.4 (4.1, 7.2) 7.5 (5.9, 9.5) 10.9 (8.9, 13.3)
Recap/Recap 5.1 (2.8, 9.3) 8.7 (5.5, 13.7) 10.3 (6.8, 15.5) 15.8 (10.9, 22.6)
*Cormet 2000 HAP 6.3 (2.9, 13.5) 8.4 (4.3, 16.1) 9.5 (5.0, 17.4) 20.0 (13.3, 29.6)
Note: * Head Component
Table IP12 Yearly Usage of Individual Total Resurfacing Hip Prostheses Identified as having a Higher than Anticipated Rate of
Revision
Year of Implant ≤2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
ASR/ASR . 43 165 302 258 176 133 91 . . . . . . .
Bionik/Bionik . . . 12 33 33 46 54 20 2 . . . . .
Cormet/Cormet 62 42 50 85 74 76 94 75 50 10 4 4 . . .
Durom/Durom . 58 166 207 143 105 88 46 24 10 . . . . .
Recap/Recap . . 27 14 9 42 46 38 16 3 . . . . .
*Cormet 2000 HAP 18 38 39 . . . . . . . . . . . .
Note: * Head Component

PRIMARY PARTIAL KNEE REPLACEMENT

PATELLA/TROCHLEA
There are no newly identified patella/trochlear
knee prostheses.
Table IP13 Revision Rate of Individual Patella/Trochlear Knee Prostheses Identified as having a Higher than Anticipated Rate of
Revision
Patella/Trochlear Hazard Ratio, P Value
**LCS 158 413 3292 4.80 Entire Period: HR=1.62 (1.35, 1.95),p<0.001
**Vanguard 12 45 197 6.08 Entire Period: HR=1.98 (1.11, 3.51),p=0.019
Note: Components have been compared to all other patella/trochlear knee components
** Trochlear Component
Table IP14 Cumulative Percent Revision of Individual Patella/Trochlear Knee Prostheses Identified as having a Higher than

**LCS 3.9 (2.4, 6.2) 11.9 (9.1, 15.4) 20.7 (17.1, 25.0) 38.4 (33.5, 43.7)
**Vanguard 4.4 (1.1, 16.6) 18.0 (9.4, 32.8) 29.2 (16.9, 47.5)
Note: ** Trochlear Component
Table IP15 Yearly Usage of Individual Patella/Trochlear Knee Prostheses Identified as having a Higher than Anticipated Rate
of Revision
Year of Implant ≤2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
**LCS 26 56 68 47 65 64 60 27 . . . . . . .
**Vanguard . . . . . 4 5 2 1 13 3 14 1 2 .
Note: ** Trochlear Component

a o a .o rg.a u 339
UNICOMPARTMENTAL
There are no newly identified
unicompartmental knee prostheses.
Table IP16 Revision Rate of Individual Unicompartmental Knee Prostheses Identified as having a Higher than Anticipated Rate
of Revision
Femoral/Tibial Hazard Ratio, P Value
GMK-UNI/GMK-UNI 19 113 322 5.89 Entire Period: HR=3.13 (2.00, 4.91),p<0.001
Uniglide/Uniglide 137 751 5897 2.32 0 - 1.5Yr: HR=1.99 (1.51, 2.63),p<0.001
. . . . 1.5Yr+: HR=1.13 (0.91, 1.40),p=0.276
Advance/Advance 16 37 275 5.81 Entire Period: HR=3.84 (2.35, 6.27),p<0.001
BalanSys Uni/BalanSys Uni Mobile 44 199 1726 2.55 0 - 6Mth: HR=4.37 (2.17, 8.78),p<0.001
. . . . 6Mth - 2Yr: HR=2.09 (1.24, 3.54),p=0.006
. . . . 2Yr+: HR=1.06 (0.70, 1.61),p=0.795
**Preservation Mobile 126 400 4027 3.13 0 - 1.5Yr: HR=2.24 (1.60, 3.14),p<0.001
. . . . 1.5Yr - 3Yr: HR=2.80 (1.91, 4.10),p<0.001
. . . . 3Yr+: HR=1.26 (0.98, 1.62),p=0.066
Note: Components have been compared to all other unicompartmental knee components
** Tibial Component
Table IP17 Cumulative Percent Revision of Individual Unicompartmental Knee Prostheses Identified as having a Higher than

GMK-UNI/GMK-UNI 7.8 (4.0, 15.1) 17.4 (11.0, 27.0)
Uniglide/Uniglide 4.9 (3.5, 6.7) 10.6 (8.6, 13.1) 12.8 (10.6, 15.5) 19.8 (16.9, 23.2)
Advance/Advance 10.8 (4.2, 26.3) 27.0 (15.6, 44.4) 32.9 (20.2, 50.6) 41.6 (27.5, 59.4)
BalanSys Uni/BalanSys Uni Mobile 7.0 (4.2, 11.6) 13.1 (9.1, 18.6) 14.6 (10.4, 20.4) 21.4 (16.2, 27.9)
**Preservation Mobile 5.3 (3.5, 7.9) 15.5 (12.3, 19.5) 19.1 (15.6, 23.3) 27.2 (23.1, 31.9)
Note: ** Tibial Component
Table IP18 Yearly Usage of Individual Unicompartmental Knee Prostheses Identified as having a Higher than Anticipated Rate
of Revision
Year of Implant ≤2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
GMK-UNI/GMK-UNI . . . . . . 5 10 2 . 21 22 16 19 18
Uniglide/Uniglide . 80 66 123 84 107 93 61 30 38 25 22 9 5 8
Advance/Advance . 13 11 7 2 3 1 . . . . . . . .
BalanSys Uni/BalanSys Uni Mobile . . 37 51 63 33 9 2 4 . . . . . .
**Preservation Mobile 164 121 59 26 17 13 . . . . . . . . .
Note: ** Tibial Component

Figure IP5 Cumulative Percent Revision of Re-identified and still used Individual Unicompartmental Knee Prostheses
35% 35%
GMK-UNI/GMK-UNI Uniglide/Uniglide
Other Unicompartmental Knee Other Unicompartmental Knee
30% 30%
25% 25%

20% 20%
15% 15%
10% 10%
5% 5%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

a o a .o rg.a u 341

The GMK Primary (cementless)/GMK Primary in the first three months compared to other
(cementless) combination is no longer total knee procedures, with there being no
identified. There have been an additional 139 difference after this time. There were four major
procedures and no further revisions. and 21 minor revisions, 16 of which were for
insert only. The main reasons for revision were
There is one tibial prosthesis identified for the first
infection (34.4%), bearing dislocation (12.5%)
time.
and loosening (9.4%).
The Legion Revision Tibial Baseplate has been
The bearing dislocation occurred when a
used in 492 primary procedures since 2006. The
degree of prosthetic constraint was used (both
cumulative percent revision at five years was
posterior and fully stabilised).
6.5%. This prosthesis had a higher rate of revision
Table IP19 Revision Rate of Individual Total Knee Prostheses Identified as having a Higher than Anticipated Rate of Revision
Newly Identified . . . .
**Legion Revision Tibial Baseplate 32 492 2087 1.53 0 - 3Mth: HR=6.25 (3.46, 11.31),p<0.001
. . . . 3Mth - 1.5Yr: HR=0.91 (0.41, 2.03),p=0.819
. . . . 1.5Yr+: HR=1.56 (0.94, 2.60),p=0.083
ACS (cless)/ACS Fixed 62 1350 3061 2.03 Entire Period: HR=2.09 (1.63, 2.69),p<0.001
Active Knee (cless)/Active Knee 490 7024 51498 0.95 0 - 3Yr: HR=1.19 (1.04, 1.35),p=0.008
. . . . 3Yr+: HR=1.83 (1.62, 2.07),p<0.001
Advance/Advance 36 755 3416 1.05 Entire Period: HR=1.41 (1.02, 1.95),p=0.039
Columbus/Columbus 92 1194 6481 1.42 Entire Period: HR=2.21 (1.80, 2.71),p<0.001
E.Motion/E.Motion 48 921 2943 1.63 0 - 1.5Yr: HR=2.66 (1.91, 3.69),p<0.001
. . . . 1.5Yr+: HR=1.07 (0.61, 1.89),p=0.813
Optetrak-PS/Optetrak 197 2778 17715 1.11 Entire Period: HR=1.77 (1.54, 2.03),p<0.001
Optetrak-PS/Optetrak-RBK 70 951 5470 1.28 Entire Period: HR=2.00 (1.58, 2.53),p<0.001
Score (cless)/Score (cless) 108 1836 7467 1.45 Entire Period: HR=1.66 (1.38, 2.01),p<0.001
Scorpio NRG PS (cless)/Series 7000 (cless) 69 1074 5622 1.23 Entire Period: HR=1.52 (1.20, 1.92),p<0.001
Trekking/Trekking 29 720 2118 1.37 0 - 1.5Yr: HR=1.96 (1.28, 3.01),p=0.002
. . . . 1.5Yr+: HR=0.97 (0.48, 1.93),p=0.924
Vanguard PS/Maxim 215 4355 19309 1.11 0 - 1.5Yr: HR=1.79 (1.50, 2.15),p<0.001
. . . . 1.5Yr+: HR=1.26 (1.03, 1.54),p=0.026
Vanguard PS/Regenerex 13 334 1318 0.99 0 - 1Yr: HR=2.66 (1.38, 5.11),p=0.003
. . . . 1Yr+: HR=0.55 (0.21, 1.47),p=0.231
ACS/ACS Mobile PC (cless) 25 131 445 5.62 Entire Period: HR=6.15 (4.16, 9.11),p<0.001
AMK/AMK 24 203 2273 1.06 Entire Period: HR=1.97 (1.32, 2.94),p<0.001
Buechel-Pappas/Buechel-Pappas 38 479 3243 1.17 Entire Period: HR=1.74 (1.26, 2.39),p<0.001
Eska RP/Eska RP 8 40 282 2.83 Entire Period: HR=5.15 (2.58, 10.27),p<0.001
Gemini MK II/Gemini MK II 7 21 193 3.63 Entire Period: HR=6.08 (2.90, 12.74),p<0.001
Genesis (ctd)/Genesis (ctd) 10 62 610 1.64 Entire Period: HR=3.21 (1.73, 5.97),p<0.001
Genesis II CR (cless)/Profix Mobile (ctd) 30 241 2249 1.33 Entire Period: HR=2.42 (1.69, 3.46),p<0.001
Genesis II Oxinium CR (cless)/Genesis II 45 110 831 5.42 0 - 1Yr: HR=10.25 (5.95, 17.67),p<0.001
. . . . 1Yr - 1.5Yr: HR=18.20 (10.07, 32.90),p<0.001
. . . . 1.5Yr - 2.5Yr: HR=20.90 (12.59, 34.71),p<0.001
. . . . 2.5Yr+: HR=2.14 (0.96, 4.76),p=0.062
Genesis II Oxinium CR (cless)/Profix Mobile 56 88 523 10.7 0 - 6Mth: HR=7.65 (2.87, 20.40),p<0.001
. . . . 6Mth - 9Mth: HR=46.94 (25.95, 84.90),p<0.001

. . . . 9Mth - 1.5Yr: HR=32.85 (21.39, 50.43),p<0.001
. . . . 1.5Yr - 2Yr: HR=27.14 (12.92, 57.00),p<0.001
. . . . 2Yr+: HR=6.60 (3.83, 11.38),p<0.001
Genesis II Oxinium PS (ctd)/Genesis II (cless) 17 56 289 5.89 0 – 1Yr: HR=16.61 (9.23, 29.91),p<0.001
. . . . 1Yr+: HR=3.56 (1.60, 7.92),p=0.001
Genesis II Oxinium PS (ctd)/Genesis II (keel) 59 269 2183 2.70 Entire Period: HR=4.50 (3.49, 5.81),p<0.001
HLS Noetos/HLS Noetos 35 294 2000 1.75 Entire Period: HR=2.71 (1.95, 3.78),p<0.001
IB II/IB II 33 199 2245 1.47 0 - 2Yr: HR=0.82 (0.26, 2.53),p=0.724
. . . . 2Yr - 2.5Yr: HR=4.60 (1.48, 14.27),p=0.008
. . . . 2.5Yr+: HR=4.20 (2.88, 6.13),p<0.001
Interax/Interax 11 52 492 2.24 0 - 3.5Yr: HR=1.43 (0.36, 5.73),p=0.610
. . . . 3.5Yr+: HR=8.12 (4.22, 15.59),p<0.001
Journey Oxinium/Journey 245 3033 18884 1.30 0 - 3Mth: HR=0.30 (0.10, 0.93),p=0.037
. . . . 3Mth - 1.5Yr: HR=1.93 (1.54, 2.41),p<0.001
. . . . 1.5Yr - 2Yr: HR=1.52 (0.99, 2.33),p=0.057
. . . . 2Yr - 2.5Yr: HR=2.03 (1.35, 3.07),p<0.001
. . . . 2.5Yr - 3Yr: HR=1.38 (0.78, 2.43),p=0.271
. . . . 3Yr+: HR=2.47 (2.04, 2.99),p<0.001
Optetrak-PS/Optetrak-PS 13 55 433 3.00 Entire Period: HR=5.60 (3.25, 9.64),p<0.001
Profix Oxinium (cless)/Profix 32 75 596 5.37 Entire Period: HR=8.19 (5.79, 11.58),p<0.001
Profix Oxinium (cless)/Profix Mobile 71 158 1160 6.12 Entire Period: HR=9.92 (7.86, 12.53),p<0.001
Profix Oxinium (ctd)/Profix Mobile 25 228 2475 1.01 Entire Period: HR=1.57 (1.06, 2.33),p=0.024
Profix/Profix Mobile 105 1005 9932 1.06 0 - 2.5Yr: HR=2.53 (1.96, 3.26),p<0.001
. . . . 2.5Yr+: HR=1.41 (1.05, 1.89),p=0.021
Rotaglide Plus/Rotaglide Plus 72 631 6341 1.14 0 - 1.5Yr: HR=1.21 (0.69, 2.13),p=0.507
. . . . 1.5Yr - 2Yr: HR=2.96 (1.48, 5.92),p=0.002
. . . . 2Yr+: HR=2.32 (1.77, 3.05),p<0.001
SAL/SAL 13 56 643 2.02 0 - 8.5Yr: HR=1.42 (0.53, 3.79),p=0.481
. . . . 8.5Yr+: HR=9.58 (4.98, 18.43),p<0.001
Trac/Trac 24 138 1486 1.62 Entire Period: HR=2.81 (1.88, 4.19),p<0.001
*LCS Duofix 582 4866 38026 1.53 0 - 2Yr: HR=1.76 (1.52, 2.04),p<0.001
. . . . 2Yr - 3.5Yr: HR=3.59 (3.06, 4.22),p<0.001
. . . . 3.5Yr - 4Yr: HR=4.88 (3.64, 6.53),p<0.001
. . . . 4Yr - 4.5Yr: HR=4.03 (2.86, 5.66),p<0.001
. . . . 4.5Yr - 5.5Yr: HR=4.50 (3.55, 5.69),p<0.001
. . . . 5.5Yr - 6.5Yr: HR=2.85 (2.09, 3.89),p<0.001
. . . . 6.5Yr+: HR=1.45 (1.10, 1.92),p=0.009
*LCS PS 55 638 3332 1.65 Entire Period: HR=2.38 (1.83, 3.10),p<0.001
*Renasys 15 121 1105 1.36 Entire Period: HR=2.44 (1.47, 4.04),p<0.001
Note: Components have been compared to all other total knee components
* Femoral Component
** Tibial Component

a o a .o rg.a u 343
Table IP20 Cumulative Percent Revision of Individual Total Knee Prostheses Identified as having a Higher than Anticipated Rate
of Revision

Newly Identified
**Legion Revision Tibial Baseplate 3.1 (1.9, 5.1) 4.9 (3.2, 7.4) 6.5 (4.4, 9.5)
ACS (cless)/ACS Fixed 1.7 (1.1, 2.6) 6.6 (5.1, 8.5)
Active Knee (cless)/Active Knee 1.1 (0.9, 1.4) 3.5 (3.1, 4.0) 5.0 (4.5, 5.6) 8.4 (7.7, 9.3)
Advance/Advance 2.0 (1.2, 3.4) 4.6 (3.2, 6.5) 5.0 (3.6, 7.1) 8.4 (5.3, 13.2)
Columbus/Columbus 1.9 (1.3, 2.9) 6.0 (4.7, 7.6) 7.7 (6.2, 9.5) 11.6 (9.2, 14.7)
E.Motion/E.Motion 2.5 (1.7, 3.8) 6.1 (4.6, 8.1) 6.3 (4.8, 8.4)
Optetrak-PS/Optetrak 1.5 (1.1, 2.0) 4.7 (3.9, 5.6) 6.4 (5.5, 7.5) 9.9 (8.5, 11.4)
Optetrak-PS/Optetrak-RBK 2.1 (1.3, 3.2) 5.4 (4.1, 7.2) 6.8 (5.2, 8.8) 11.1 (8.4, 14.5)
Score (cless)/Score (cless) 1.5 (1.0, 2.2) 5.2 (4.2, 6.5) 7.2 (5.9, 8.8)
Scorpio NRG PS (cless)/Series 7000 (cless) 1.3 (0.8, 2.3) 5.8 (4.5, 7.5) 7.3 (5.8, 9.2)
Trekking/Trekking 2.4 (1.5, 3.9) 4.0 (2.7, 5.9) 5.8 (3.8, 8.8)
Vanguard PS/Maxim 1.8 (1.5, 2.3) 4.4 (3.8, 5.1) 5.5 (4.8, 6.3) 7.2 (6.0, 8.7)
Vanguard PS/Regenerex 3.0 (1.6, 5.7) 4.7 (2.7, 8.0) 4.7 (2.7, 8.0)
ACS/ACS Mobile PC (cless) 7.7 (4.2, 13.8) 18.6 (12.9, 26.5)
AMK/AMK 1.0 (0.2, 3.9) 5.0 (2.7, 9.1) 6.6 (3.9, 11.1) 11.3 (7.5, 16.9) 13.2 (8.9, 19.4)
Buechel-Pappas/Buechel-Pappas 1.9 (1.0, 3.6) 5.5 (3.8, 8.0) 7.7 (5.6, 10.5)
Eska RP/Eska RP 7.5 (2.5, 21.5) 12.7 (5.5, 27.9) 18.2 (9.1, 34.5) 21.1 (11.1, 37.9)
Gemini MK II/Gemini MK II 9.5 (2.5, 33.0) 14.3 (4.8, 38.0) 23.8 (10.7, 48.1) 23.8 (10.7, 48.1)
Genesis (ctd)/Genesis (ctd) 0.0 (0.0, 0.0) 6.7 (2.6, 16.8) 10.0 (4.6, 20.9) 16.1 (8.6, 28.9)
Genesis II CR (cless)/Profix Mobile (ctd) 2.9 (1.4, 6.1) 7.7 (4.9, 11.9) 9.5 (6.3, 14.0) 12.6 (8.7, 18.0)
Genesis II Oxinium CR (cless)/Genesis II 11.9 (7.1, 19.7) 39.2 (30.7, 49.1) 40.2 (31.6, 50.1) 41.2 (32.5, 51.2)
Genesis II Oxinium CR (cless)/Profix Mobile 24.0 (16.3, 34.4) 52.8 (42.8, 63.5) 57.4 (47.4, 67.9) 61.1 (51.0, 71.3)
Genesis II Oxinium PS (ctd)/Genesis II (cless) 19.6 (11.4, 32.7) 26.8 (17.1, 40.4) 30.4 (20.1, 44.2)
Genesis II Oxinium PS (ctd)/Genesis II (keel) 4.5 (2.6, 7.7) 14.5 (10.8, 19.3) 18.7 (14.5, 23.9) 22.3 (17.7, 27.8)
HLS Noetos/HLS Noetos 3.4 (1.8, 6.2) 8.6 (5.9, 12.4) 10.8 (7.7, 14.9)
IB II/IB II 0.0 (0.0, 0.0) 3.6 (1.7, 7.3) 7.8 (4.8, 12.7) 15.4 (10.9, 21.5)
Interax/Interax 0.0 (0.0, 0.0) 2.0 (0.3, 13.4) 8.3 (3.2, 20.7) 13.0 (6.0, 26.8)
Journey Oxinium/Journey 1.4 (1.0, 1.9) 4.6 (3.9, 5.4) 6.4 (5.6, 7.4) 10.9 (9.4, 12.7)
Optetrak-PS/Optetrak-PS 1.8 (0.3, 12.2) 16.4 (8.9, 29.1) 20.0 (11.6, 33.3) 24.4 (14.9, 38.5)
Profix Oxinium (cless)/Profix 13.3 (7.4, 23.4) 36.1 (26.4, 48.1) 37.5 (27.6, 49.5) 42.0 (31.7, 54.2)
Profix Oxinium (cless)/Profix Mobile 9.0 (5.4, 14.6) 40.2 (32.9, 48.3) 41.5 (34.2, 49.7) 46.0 (38.4, 54.3)
Profix Oxinium (ctd)/Profix Mobile 1.8 (0.7, 4.6) 6.3 (3.8, 10.4) 8.6 (5.5, 13.1) 10.9 (7.4, 15.8)
Profix/Profix Mobile 2.3 (1.5, 3.4) 6.4 (5.0, 8.1) 8.2 (6.6, 10.1) 9.9 (8.2, 12.0)
Rotaglide Plus/Rotaglide Plus 0.8 (0.3, 1.9) 4.1 (2.8, 6.0) 5.8 (4.2, 8.0) 10.9 (8.6, 13.8)
SAL/SAL 0.0 (0.0, 0.0) 1.9 (0.3, 12.6) 1.9 (0.3, 12.6) 14.8 (7.3, 28.6)
Trac/Trac 2.2 (0.7, 6.6) 5.9 (3.0, 11.4) 9.0 (5.2, 15.2) 15.1 (9.9, 22.7)
*LCS Duofix 1.5 (1.2, 1.9) 5.9 (5.3, 6.6) 9.6 (8.8, 10.5) 12.9 (11.9, 13.9)
*LCS PS 2.1 (1.2, 3.5) 6.7 (5.0, 9.0) 8.8 (6.7, 11.3)
*Renasys 2.5 (0.8, 7.5) 4.2 (1.8, 9.8) 8.5 (4.6, 15.1) 11.2 (6.7, 18.5)
Note: * Femoral Component

** Tibial Component

Table IP21 Yearly Usage of Individual Total Knee Prostheses Identified as having a Higher than Anticipated Rate of Revision
Year of Implant ≤2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Newly Identified . . . . . . . . . . . . . . .
**Legion Revision Tibial Baseplate . . . . 16 33 48 40 56 47 63 54 47 38 50
ACS (cless)/ACS Fixed . . . . . . . . . 41 119 283 337 332 238
Active Knee (cless)/Active Knee 221 613 790 693 466 510 483 412 479 601 500 427 318 335 176
Advance/Advance 54 . 8 12 16 2 5 43 115 138 74 7 92 91 98
Columbus/Columbus . . . 49 91 90 148 156 134 136 108 69 36 60 117
E.Motion/E.Motion . . . . . . . 12 87 114 129 236 106 113 124
Optetrak-PS/Optetrak 126 130 155 252 253 216 168 202 198 202 200 151 117 202 206
Optetrak-PS/Optetrak-RBK . . . 1 81 173 166 119 82 40 37 50 100 56 46
Score (cless)/Score (cless) . . . 1 . 11 135 212 187 204 195 238 252 249 152
Scorpio NRG PS (cless)/Series 7000 (cless) . . . . . 76 185 171 166 114 67 71 76 72 76
Trekking/Trekking . . . . . . . . 35 102 133 107 108 106 129
Vanguard PS/Maxim . . . 22 82 146 318 424 479 600 561 444 516 439 324
Vanguard PS/Regenerex . . . . . . . 4 121 54 27 15 21 18 74
ACS/ACS Mobile PC (cless) . . . . . . . . . 20 37 57 17 . .
AMK/AMK 200 2 1 . . . . . . . . . . . .
Buechel-Pappas/Buechel-Pappas . . . 1 39 51 84 100 148 44 4 . 7 1 .
Eska RP/Eska RP . . . 9 24 5 . 2 . . . . . . .
Gemini MK II/Gemini MK II 14 7 . . . . . . . . . . . . .
Genesis (ctd)/Genesis (ctd) 45 6 3 8 . . . . . . . . . . .
Genesis II CR (cless)/Profix Mobile (ctd) 126 26 10 4 2 5 12 6 9 17 2 22 . . .
Genesis II Oxinium CR (cless)/Genesis II 4 106 . . . . . . . . . . . . .
Genesis II Oxinium CR (cless)/Profix Mobile 22 66 . . . . . . . . . . . . .
Genesis II Oxinium PS (ctd)/Genesis II (cless) . . . . . 4 4 11 35 1 1 . . . .
Genesis II Oxinium PS (ctd)/Genesis II (keel) . . . 19 123 127 . . . . . . . . .
HLS Noetos/HLS Noetos . . 2 2 47 45 45 56 48 28 20 1 . . .
IB II/IB II 187 12 . . . . . . . . . . . . .
Interax/Interax 52 . . . . . . . . . . . . . .
Journey Oxinium/Journey . . . . 134 337 541 555 464 334 343 325 . . .
Optetrak-PS/Optetrak-PS . . 8 14 18 15 . . . . . . . . .
Profix Oxinium (cless)/Profix 10 65 . . . . . . . . . . . . .
Profix Oxinium (cless)/Profix Mobile 63 95 . . . . . . . . . . . . .
Profix Oxinium (ctd)/Profix Mobile 72 31 91 24 3 4 1 2 . . . . . . .
Profix/Profix Mobile 197 173 258 245 51 56 11 12 2 . . . . . .
Rotaglide Plus/Rotaglide Plus 181 151 110 101 43 30 15 . . . . . . . .
SAL/SAL 56 . . . . . . . . . . . . . .
Trac/Trac 128 9 1 . . . . . . . . . . . .
*LCS Duofix . . . . 843 1636 1532 854 1 . . . . . .
*LCS PS . . . . . . 8 157 203 109 51 69 39 2 .
*Renasys . . . 51 53 3 14 . . . . . . . .
Note: * Femoral Component

** Tibial Component

a o a .o rg.a u 345
Figure IP6 Cumulative Percent Revision of Newly Identified Individual Total Knee Prostheses
Newly identified
20%
**Legion Revision Tibial Baseplate
18% Other Total Knee
16%

14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Figure IP7 Cumulative Percent Revision of Re-identified and still used Individual Total Knee Prostheses
20% 20%
ACS (cless)/ACS Fixed Active Knee (cless)/Active Knee
18% Other Total Knee 18% Other Total Knee
16% 16%

14% 14%
12% 12%
10% 10%
8% 8%
6% 6%
4% 4%
2% 2%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
20% 20%
Advance/Advance Columbus/Columbus
16% 16%
14% 14%
12% 12%
10% 10%
8% 8%
6% 6%
4% 4%
2% 2%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
20% 20%
E.Motion/E.Motion Optetrak-PS/Optetrak
16% 16%
14% 14%
12% 12%
10% 10%
8% 8%
6% 6%
4% 4%
2% 2%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

a o a .o rg.a u 347
20% 20%
Optetrak-PS/Optetrak-RBK Score (cless)/Score (cless)
16% 16%

14% 14%
12% 12%
10% 10%
8% 8%
6% 6%
4% 4%
2% 2%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
20% 20%
Scorpio NRG PS (cless)/Series 7000 (cless) Trekking/Trekking
16% 16%
14% 14%
12% 12%
10% 10%
8% 8%
6% 6%
4% 4%
2% 2%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
20% 20%
Vanguard PS/Maxim Vanguard PS/Regenerex
16% 16%
14% 14%
12% 12%
10% 10%
8% 8%
6% 6%
4% 4%
2% 2%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

PRIMARY PARTIAL SHOULDER REPLACEMENT

HEMI STEMMED
There are no newly identified hemi stemmed
shoulder prostheses.
Table IP22 Revision Rate of Individual Hemi Stemmed Shoulder Prostheses Identified as having a Higher than Anticipated Rate
of Revision
Humeral Stem/Head Hazard Ratio, P Value
Delta Xtend/Delta Xtend 9 62 242 3.71 Entire Period: HR=2.15 (1.11, 4.17),p=0.023
Global Unite/Global Unite 20 150 291 6.88 Entire Period: HR=2.23 (1.41, 3.52),p<0.001
Note: Components have been compared to all other hemi stemmed shoulder components
Table IP23 Cumulative Percent Revision of Individual Hemi Stemmed Shoulder Prostheses Identified as having a Higher than

Delta Xtend/Delta Xtend 6.9 (2.6, 17.2) 16.5 (8.9, 29.5) 16.5 (8.9, 29.5) 16.5 (8.9, 29.5)
Global Unite/Global Unite 4.5 (2.0, 9.7)
Table IP24 Yearly Usage of Individual Hemi Stemmed Shoulder Prostheses Identified as having a Higher than Anticipated Rate
of Revision
Year of Implant ≤2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Re-Identified and Still Used . . . . . . . . . .
Delta Xtend/Delta Xtend 2 5 9 9 5 10 7 6 5 4
Global Unite/Global Unite . . . . . 15 37 25 38 35
Figure IP8 Cumulative Percent Revision of Re-Identified and Still Used Hemi Stemmed Shoulder Prostheses
Re-Identified and still used
35% 35%
Delta Xtend/Delta Xtend Global Unite/Global Unite
Other Hemi Stemmed Shoulder Other Hemi Stemmed Shoulder
30% 30%
25% 25%
20% 20%
15% 15%
10% 10%
5% 5%
0% 0%
0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10

a o a .o rg.a u 349
PRIMARY TOTAL SHOULDER REPLACEMENT

TOTAL CONVENTIONAL
There are no newly identified total conventional
Table IP25 Revision Rate of Individual Total Conventional Shoulder Prostheses Identified as having a Higher than Anticipated
Rate of Revision
Humeral Stem/Glenoid Hazard Ratio, P Value
SMR/SMR L1 199 1765 6888 2.89 0 - 1.5Yr: HR=2.39 (1.95, 2.95),p<0.001
. . . . 1.5Yr+: HR=1.37 (1.06, 1.78),p=0.016
SMR/SMR L2 264 856 3873 6.82 0 - 6Mth: HR=3.11 (2.12, 4.55),p<0.001
. . . . 6Mth - 1.5Yr: HR=5.19 (3.99, 6.76),p<0.001
. . . . 1.5Yr+: HR=8.01 (6.47, 9.91),p<0.001
Univers 3D/Univers 3D 12 34 232 5.18 Entire Period: HR=3.83 (2.16, 6.79),p<0.001
Vaios/Vaios 15 36 136 11.0 Entire Period: HR=6.21 (3.73, 10.37),p<0.001
Note: Components have been compared to all other total conventional shoulder components
Table IP26 Cumulative Percent Revision of Individual Total Conventional Shoulder Prostheses Identified as having a Higher
than Anticipated Rate of Revision

SMR/SMR L1 5.8 (4.8, 7.0) 10.8 (9.4, 12.5) 12.7 (10.9, 14.6) 14.2 (12.3, 16.5)
SMR/SMR L2 9.5 (7.7, 11.7) 22.2 (19.6, 25.2) 29.8 (26.8, 33.0)
Univers 3D/Univers 3D 5.9 (1.5, 21.5) 14.7 (6.4, 31.8) 21.2 (10.7, 39.4) 31.0 (18.0, 50.1)
Vaios/Vaios 13.9 (6.0, 30.2) 27.8 (16.0, 45.5) 41.6 (26.6, 60.7)
Table IP27 Yearly Usage of Individual Total Conventional Shoulder Prostheses Identified as having a Higher than Anticipated
Rate of Revision
Year of Implant ≤2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
SMR/SMR L1 135 237 247 . . 157 301 255 239 194
Identified and no longer used . . . . . . . . . .
SMR/SMR L2 . . 43 343 336 134 . . . .
Univers 3D/Univers 3D 23 11 . . . . . . . .
Vaios/Vaios . . . . 16 17 2 1 . .
Note: The SMR L1 was not used in 2010 and 2011 due to the exclusive use of the SMR L2 in total conventional shoulder replacement

Figure IP9 Cumulative Percent Revision of Re-identified and still used Individual Total Conventional Shoulder Prostheses
24%
SMR/SMR L1
22% Other Total Conventional Shoulder
20%
18%

16%
14%
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10

a o a .o rg.a u 351
PRIMARY TOTAL REVERSE SHOULDER REPLACEMENT

There are no newly identified total reverse
Table IP28 Revision Rate of Individual Total Reverse Shoulder Prostheses Identified as having a Higher than Anticipated Rate of
Revision
Humeral Stem/Glenoid Hazard Ratio, P Value
SMR/SMR L1 172 3739 10224 1.68 Entire Period: HR=1.40 (1.17, 1.68),p<0.001
Note: Components have been compared to all other total reverse shoulder components
Table IP29 Cumulative Percent Revision of Individual Total Reverse Shoulder Prostheses Identified as having a Higher than

SMR/SMR L1 3.8 (3.2, 4.5) 4.9 (4.2, 5.7) 5.8 (4.9, 7.0) 6.6 (5.4, 8.0)
Table IP30 Yearly Usage of Individual Total Reverse Shoulder Prostheses Identified as having a Higher than Anticipated Rate of
Revision
Year of Implant ≤2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
SMR/SMR L1 145 261 271 . . 249 562 627 727 897
Note: The SMR L1 was not used in 2010 and 2011 due to the exclusive use of the SMR L2 in total reverse shoulder replacement
Figure IP10 Cumulative Percent Revision of Re-identified and still used Individual Total Reverse Shoulder Prostheses
14%
SMR/SMR L1
Other Total Reverse Shoulder
12%
10%
8%
6%
4%
2%
0%
0 1 2 3 4 5 6 7 8 9 10

PRIMARY TOTAL ANKLE REPLACEMENT
There are no newly identified total ankle prosthesis.
Table IP1 Revision Rate of Individual Total Ankle Prostheses Identified as having a Higher than Anticipated Rate of
Revision
Talar/Tibial Tray Hazard Ratio, P Value
S.T.A.R/S.T.A.R 7 48 145 4.83 Entire Period: HR=2.28 (1.07, 4.88),p=0.033
Note: Components have been compared to all other ankle components
Table IP2 Cumulative Percent Revision of Individual Total Ankle Prostheses Identified as having a Higher than

S.T.A.R/S.T.A.R 4.4 (1.1, 16.4) 16.3 (7.4, 33.6) 16.3 (7.4, 33.6)
Table IP3 Yearly Usage of Individual Total Ankle Prostheses Identified as having a Higher than Anticipated Rate of
Revision
Year of Implant ≤2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
S.T.A.R/S.T.A.R 1 . 3 3 4 2 15 12 4 4
Figure IP1 Cumulative Percent Revision of Re-identified and still used Individual Total Ankle Prostheses
Re-Identified and still used
40%
S.T.A.R/S.T.A.R
Other Total Ankle
35%
30%
25%
20%
15%
10%
5%
0%
0 1 2 3 4 5 6 7 8 9 10

a o a .o rg.a u 353
Appendices
Appendices
APPENDIX 1
PARTICIPATING HOSPITALS & COORDINATORS
VICTORIA
PUBLIC HOSPITALS PRIVATE HOSPITALS
Austin Health Ross Kentish/Bev Murray Beleura Private Hospital Jean Leyland
Bairnsdale Regional Health Service Sian Guns Bellbird Private Hospital Belinda Van Denberg
Ballarat Health Services Bernie Anderson/Kellie Livingston Cabrini Private Hospital, Brighton Sandy Scherer
Bass Coast Regional Health Debbie Rogers/Simonne Liberman Cabrini Private Hospital, Malvern Sandy Scherer
Bendigo Health Care Group Catherine Jensen/Shelly Sharp Como Private Hospital Gillian Wilson/Nicole Groves
Box Hill Hospital Lisa Bingham Cotham Private Hospital Marianne Westley
Cohuna District Hospital Karyn Storm Epworth Hospital Lynne Moyes
Colac Area Health Amanda Tout Epworth Eastern Hospital Kylie Longley/Janine Cope
Dandenong Hospital Karen Ferguson/Melanie Murray Epworth Freemason Hospital Claudia Nozzolillo
Djerriwarrh Health Services Kate Anderson/Judy Dehnert Epworth Geelong Dianne Buttigieg/Julia Castro
East Grampians Health Service Jane Smith/Jenny Sargent Essendon Private Hospital Elaine Jordan
Echuca Regional Health Kerryn Giorgianni Frankston Private Hospital Tracey McIndoe
Goulburn Valley Health Cara Disint Geelong Private Hospital Wilna Steyn
Hamilton Base Hospital Rosalie Broadfoot Glenferrie Private Hospital Samantha Jervios
Kerang District Health Margie Christian John Fawkner Hospital Belinda Emmett
Kyabram & District Health Services Lynda Walker Knox Private Hospital Bronwyn Hawkins/Laura Tilley
Latrobe Regional Hospital Simone Lovison Linacre Private Hospital Melissa Dillon/Denice Tyler
Maroondah Hospital Satish Singh Maryvale Private Hospital Glenda Chambers
Mildura Base Hospital Katrina Allen Masada Private Hospital Anna Bonato/Lisa Butler
Monash Medical Centre, Clayton Jessica Cranston Melbourne Private Hospital Karen Grant/Tracey Perkins
Monash Medical Centre, Moorabbin Carol Jackson/Lisa Mason Mildura Private Hospital Sue Malcolm
Northeast Health Wangaratta Lynn Reid/Larissa Benci Mitcham Private Hospital Julie Nankivell/Joshie Lonthyil
Peninsula Health Service, Frankston Donna Anderson Northpark Private Hospital Kath Morris
Portland Hospital Julie Sealey Peninsula Private Hospital Ruth Honan
Sandringham & District Memorial Rebecca Harouche/Trang Le Ringwood Private Hospital Carol Burns
Seymour District Memorial Hospital Karen Lamaro Shepparton Private Hospital Niki Miller
South West Healthcare Tony Kelly St John of God Ballarat Hospital Gitty Mathachan
St Vincent’s Public Hospital Shazeli Osman/Ridwaan Khan St John of God Bendigo Hospital Margaret Brown/Alanna Sheehan
Stawell Regional Health Sue Campigli/Judy Body St John of God Geelong Hospital Colin Hay
Sunshine Hospital Cassandra Mules St John of God Warrnambool Leanne McPherson/Gill Wheaton
Swan Hill District Hospital Helen Wilkins St John of God Hospital, Berwick Rebecca Jamieson
The Alfred Caroline McMurray St Vincent’s Private East Melb Jan Gammon
The Northern Hospital Siew Perry St Vincent’s Private Fitzroy Naomi Carter/Deanna Dellevirgini
The Royal Children’s Hospital Sonia Mouat St Vincent’s Private Kew Joy Miller/Sue Zidziunas
The Royal Melbourne Hospital Brychelyn Bennett The Avenue Hospital John Davidson
Uni Hospital Geelong Barwon Health David Barber/Michelle Quinn The Bays Romany Goonan
West Gippsland Healthcare Group Stefanie Backman/Bernie Norman The Melbourne East Private Jay Phillpotts
West Wimmera Health Service Sharon Sanderson/Christine Dufty The Valley Private Hospital Anthony Puzon
Western Hospital Vicki Mahaljcek/Cassandra Mules Wangaratta Private Hospital Janet McKie
Williamstown Hospital Paul Buso/Maureen Clark Warringal Hospital Marilyn Dey/Jodie Werkowski
Wimmera Health Care Group Maree Markby Waverley Private Hospital Alfred Monleon
Western Private Hospital Abbie Grech

a o a .o rg.a u 355
NEW SOUTH WALES

Albury Base Hospital Laurel Rhodes Albury Wodonga Private Hospital Ben Sutton
Armidale Hospital Amber Prater Armidale Private Hospital Katherine Latter
Bankstown/Lidcombe Hospital Karen Och Baringa Private Hospital Karla Hannaford
Bathurst Base Hospital Kylie Peers Bathurst Private Hospital Diane Carter
Blacktown Hospital June Tsang Berkeley Vale Private Hospital Michelle Turner
Bowral and District Hospital Barbara Wise Brisbane Waters Private Hospital Adele Ryan
Broken Hill Health Service Sue Beahl/Brock Roberts Calvary Health Care Riverina Annette Somerville
Campbelltown Hospital Susan Birch Campbelltown Private Hospital Yvonne Quinn
Canterbury Hospital Jenny Cubitt Dalcross Adventist Hospital Anne Carroll/Kerrie Legg
Coffs Harbour Health Campus Eric Dorman Delmar Private Hospital Cathy Byrne
Concord Repatriation Hospital David Debello Dubbo Private Hospital Sallie Cross/Kim Troth
Dubbo Base Hospital Kathy Chapman Dudley Private Hospital Michele Englart/Pam Fullgrabe
Fairfield Hospital Caroline Youkhana East Sydney Private Dane Browne/Jane Telfer
Gosford Hospital Kirstie Brown/Toni Hoad Forster Private Hospital Margaret Parish
Goulburn Base Hospital Karen Goode/Debbie Hay Gosford Private Hospital Melissa McLean
Grafton Base Hospital Anthony Corkett Hawkesbury District Health Service Sharon Garden/Elizabeth Jones
Hornsby & Ku-Ring-Gai Hospital Bessie Chu Holroyd Private Hospital Christine Aldana
Inst Rheum & Orthopaedic Surgery Maria Hatziandreou Hospital for Specialist Surgery Hailey MacAllister
John Hunter Hospital Felicia Bristow Hunters Hill Private Jenny May
Lismore Base Hospital Glen Nettle Hunter Valley Private Renae Ross
Liverpool Health Service John Murphy Hurstville Private Simelibuhle Masuku
Maitland Hospital Karen Cheers Insight Clinic Private Hospital Debbie van de Stadt
Manly District Hospital Heather Liddle/Maryann Howell Kareena Private Hospital Tanja Radic
Manning Rural Referral Hospital Grahame Cooke Lake Macquarie Private Hospital Edward Miles/Fiona Lindsay
Mona Vale Hospital Bronwyn Friend Lingard Private Hospital Nicole Garland/Ian Jones
Mt Druitt Hospital Charmaine Boyd Maitland Private Hospital Martine Mead/Joanne Chalmers
Murwillumbah District Hospital Linda Gahan Macquarie University Hospital Julie Guthrie
Nepean Hospital Debbie Dobbs Mayo Private Hospital Janet Hickman
Orange Health Service Alexandra Woods National Day Surgery Sydney Stephanie Schofield/Kerry Gardner
Port Macquarie Base Hospital Fiona Cheney/Jo Atkins Nepean Private Hospital Lauren Bradford
Royal Newcastle Centre Graham Cutler Newcastle Private Hospital Darren Fogarty
Royal North Shore Hospital Kay Crawford North Shore Private Hospital Satheesh Jose
Royal Prince Alfred Hospital Chris Chiapoco/Jennifer Wilkie Norwest Private Hospital Reece Shepherd
Ryde Hospital Karen Jones Nowra Private Hospital Linda Wright
Shoalhaven District Memorial Hospital Leanne McTavish Port Macquarie Private Hospital Tresna Bell
South East Regional Hospital Leanne Williams Shellharbour Private Hospital Jenny Fraser
St George Hospital Simon Cheng Southern Highlands Hospital Lynne Byrne
St Vincent’s Public Hospital MT Butler/L Black/A Baker St George Private & Medical Centre Lee Mayo/Susy Tanevska
Sutherland Hospital Sara Hogan St Luke's Care Robbie Bentley
Tamworth Base Hospital David Marsh St Vincent’s Private Darlinghurst Fiona Crawford/ Vivien Law
The Children’s Hospital Westmead Ariella Galstaun St Vincent’s Private Lismore Janelle Hospers
The Prince of Wales Hospital F O’Brien/L Robertson/C Noema Strathfield Private Hospital John Mati
The Tweed Hospital Amanda Budd/Neroli Prestage Sydney Adventist Hospital Jill Parker/Melissa Ng
Wagga Wagga Base Hospital Alison Giese/Melissa O’Reilly Sydney Private Hospital Margaret Haughton
Westmead Public Hospital Dee Martic Sydney South West Private Lucy Richardson
Wollongong Hospital Carol Jackson Tamara Private Hospital Kris Wall
Wyong Hospital Marilyn Randall The Mater Hospital Namor Guerrero
The Prince of Wales Private Ellaine Perez/Paula Civit Diez
Toronto Private Hospital Stephanie Keys
Waratah Private Hospital Kim Bassot
Warners Bay Private Hospital Annette Harrison
Westmead Private Hospital Katrina Teren
Wollongong Private Hospital Kim Dyer/Mandy Holmes

QUEENSLAND
Bundaberg Base Hospital J Anderson/J Larsen/D Norman Brisbane Private Hospital Julie Oddy/Liz Drabble
Cairns Base Hospital Sharon Ryrie Caboolture Private Hospital Dee Ireland
Gold Coast Hospital, Robina Campus Annemarie Brooks/Helen McGuire Cairns Private Hospital Louisa Smit
Gold Coast University Hospital Karen Morton Friendly Society’s Hospital Karen Smith
Hervey Bay Hospital Elaine Loots Gold Coast Private Hospital Kathryn Schott
Ipswich Hospital Ross Howells/Jannah O’Sullivan Gold Coast Surgical Hospital Damien Knight
Lady Cilento Children’s Hospital Andrew Jesbert/Aimee Reid Greenslopes Private Hospital Kelly Williams/Rhonda Griffin
Logan Hospital Denise Maher Hervey Bay Surgical Centre Margo Christensen
Mackay Base Hospital Michelle Lanigan/Beth Keogh Hillcrest Rockhampton Private Lyn Martin
Maryborough Hospital H Zillmann/B Christiansen Holy Spirit Northside Hospital Lexie Shannon
Mater Misericordiae Public Adult’s Craig Steains John Flynn Hospital Paula Archer
Nambour General Hospital Fiona Tognolini Mater Health Services North Qld Jo Humphreys/Anjela Hunt
Prince Charles Hospital Louise Tuppin/Rose Seddon Mater Misericordiae Bundaberg Catherine Hackney
Princess Alexandra Hospital Jo-Anne de Plater Mater Misericordiae Gladstone Saroj Saini
Queen Elizabeth II Jubilee Hospital Donna Cal Mater Misericordiae Mackay Judith McDonald
Redcliffe Hospital Gemma van Fleet/Emily Currie Mater Misericordiae Rockhampton Michelle Havik/Tim Harkin
Redland Public Hospital Sara Mackenzie Mater Misericordiae Private Hospital Justine Jones
Rockhampton Base Hospital Gabrielle Sellen Mater Private Hospital Redland Merryl Hoey
Royal Brisbane & Women’s Emma Babao/Anna Dowe Mater Private Springfield Carole James/Krystal Lording
Sunshine Coast University Hospital Sandy Colquist Nambour Selangor Private Hospital Simon Pfeiffer/Trevor Dempsey
Toowoomba Hospital Amanda Lostroh/Freya Chadwick Noosa Hospital Janet McMeekin
Townsville Hospital Tara Cudmore North West Private Hospital Teressa Auckland/David Campbell
Peninsula Private Hospital Lesley Henderson
Pindara Private Hospital Michael Young/Esther Moire
St Andrew’s Private Hospital, Ipswitch Mel Grant
St Andrew’s Hospital, Toowoomba Jeff van Leeuwen
St Andrew’s War Memorial Hospital Kerrie Jenkins
St Stephen’s Private Hospital Wendy Simmers
St Vincent’s Hospital, Toowoomba Judy Plotecki
Sunnybank Private Hospital Francina Robinston
Sunshine Coast University Private Tanya Prothero
The Sunshine Coast Hospital Phil Hall
Wesley Hospital Carole Gregory/Kalpana Patel
WESTERN AUSTRALIA
Albany Regional Hospital Jodie Hayton Bethesda Hospital H Hanekom/H Collis/J Fitzroy
Armadale Health Service Eleri Griffiths/Deb Carkeek Hollywood Private Hospital Michelle Connor
Bunbury Regional Hospital Anthea Amonini Joondalup Health Campus D Crowley/J Holmes/P Villanova/E Yates
Fremantle Hospital Elsy Jiji Mount Hospital Jacqui McDonald
Fiona Stanley Hospital Jarrod Duncan Peel Health Campus Nicolle Turton
Geraldton Hospital Vicki Richards South Perth Hospital Deb Waters
Kalgoorlie Regional Hospital Nicole Hintz St John of God Health Care Bunbury Alison Hawkes
Osborne Park Hospital Jenny Misiewicz St John of God Health Care Geraldton Teresa Wood
Rockingham General Hospital Carol Beaney St John of God Health Care Midland Grace Loh
Royal Perth Hospital, Wellington St Kerry Hodgkinson St John of God Health Care Murdoch Christopher Sheen
Sir Charles Gairdner Hospital Angela Bibb St John of God Mt Lawley Francisco Campos/Stuart Meek
St John of God Health Care Subiaco Andy Sullivan
Waikiki Private Hospital Bill Muir

a o a .o rg.a u 357
SOUTH AUSTRALIA
Clare Hospital and Health Services Melissa Bradley/Jo Knappstein Ashford Community Hospital Lisa Kowalik
Flinders Medical Centre Amy Ware Burnside War Memorial Hospital Brooke Drechsler
Gawler Health Service Sharon Mewett Calvary Central Districts Hospital Linda Keech
Lyell McEwin Hospital Craig Keley Calvary North Adelaide Hospital Maria Young
Modbury Public Hospital Lisa Pearson Calvary Wakefield Hospital F Hansen/I Snowball/T Heinrich
Mt Barker DSM Hospital Emma Crowder Flinders Private Hospital Marcus Ender
Mt Gambier Regional Hospital Kylie Duncan Glenelg Community Hospital N Russell-Higgins/VLawrence
Murray Bridge Soldiers Memorial Janine Colwell North Eastern Community Hospital Anne Sciacca
Naracoorte Health Service Trina Berry Parkwynd Private Hospital Anna-Claire Naylor
Noarlunga Hospital Carole Dawson Sportsmed SA F Penning/S Smith/K Stapleton/M Odgaard
Port Augusta Janine Haynes/Paola Williams St Andrew’s Private Hospital H Crosby/L White
Port Lincoln Hospital Christine Weber Stirling District Hospital Nick Clarke/Tanya Hanlon
Port Pirie Hospital Sue Wilkinson The Memorial Hospital E Carroll/J Ohlson
Queen Elizabeth Hospital Renae Wauchope Western Hospital Sharon Till
Repatriation General Hospital Joy Telfer/Alistair Smith
Riverland Regional Hospital Leanne Zerna
Royal Adelaide Hospital Lisa Lewington
South Coast District Hospital Anne Price/Jo Hunt
Whyalla Health Service Michael Prunty
Women’s and Children’s Hospital Margaret Betterman
TASMANIA
Launceston General Hospital E Davidson/M Postmus Calvary Health Care, St John’s Cate Farrell
North West Regional, Burnie Campus B Kerr/ R Dicker Calvary Health Care, St Luke’s Gary Stratton/Toni Morice
Royal Hobart Hospital Stuart Kirkham Calvary Hospital B Stephensen/A Copping/S Ransley
Hobart Private Hospital Janine Dohnt
North-West Private Hospital Kylie Smith
AUSTRALIAN CAPITAL TERRITORY

The Canberra Hospital Helen Boyd/Jose Abraham Calvary John James Memorial Hospital Samjith Sreesan
Calvary Health Care ACT Rebecca Covington The National Capital Private M Liebhardt/G Palada
Calvary Health Care ACT Rebecca Covington
Canberra Private Hospital M Gower/S Phillips/M Rogina/L Tuohy
NORTHERN TERRITORY
Alice Springs Hospital Debra Mullan Darwin Private Hospital Beverley Hinchcliffe/Vanessa Frewin
Royal Darwin Hospital Tanya Anderson/Wendy Rogers

APPENDIX 2
GLOSSARY
Statistical Terms
Adjustment: The process of re-estimating a crude measure, such as a rate or rate ratio, to minimise the
effects of a difference in the distribution of a characteristic, such as age, between groups being
compared on that measure. Adjustment may be carried out in the context of a modelling procedure,
for example, linear or proportional hazards regression models, or by standardising the data set against
a reference population with a known age distribution, for example, the World Standard Population or
the Australian population defined by the Australian Bureau of Statistics Census in a specified year.
Censoring: When the outcome of interest is the time to a defined event, for example, revision of a
prosthesis, the event may not occur during the available period of observation. For example, the
Registry analyses its data on prosthesis revision for the period ending 31 December each year, and
many prostheses will not have been revised by that time. Unless the prosthesis was revised prior to 31
December the outcome is unknown. For the majority, we only know that up until 31 December they
had not yet been revised. The times to revision for these prostheses are said to have been censored
at 31 December. Statistical methods exist to ensure that censored data are not ignored in analysis,
rather information on survival up until the time of censoring is used to give the best possible estimates
of survival or revision probabilities.
Chi-Square Test (2) Test: Any test whose statistic has a chi-square distribution under the null
hypothesis is called a chi-square test. A common example is a test for association between two
categorical variables whose data are arrayed in a cross-classification table of counts (Pearson’s chi-
square test). This can be generalised to many situations where the distribution of observed data is
being compared to an expected theoretical distribution.
Competing Risk: Any event that changes the probability of occurrence of another event is known as
a competing risk for the other event. For example, death is a competing risk for revision because the
probability of revision after death cannot be assumed to be the same as the probability of revision
before death. Another example is that if interest centres on specific causes of revision, then each
cause (infection, loosening etc) is a competing risk for each other cause. Treating a competing risk
event as a right censoring will bias the estimation of the risk of the event of interest.
Confidence Interval: A set of values for a summary measure, such as a rate or rate ratio, constructed
so the set has a specified probability of including the true value of the measure. The specified
probability is called the confidence interval, the end points are called lower and upper confidence
limits; 95% confidence intervals are most common.
Cox Model or Proportional Hazards Model: A statistical model that relates the hazard for an individual
at any time t to an (unspecified) baseline hazard and a set of predictor variables, such as treatment
type, age, gender etc. The Cox model produces hazard ratios that allow comparisons between
groups of the rate of the event of interest. The main assumption of a Cox model is that the ratio of
hazards between groups that we wish to compare does not vary over time. If the hazard for prosthesis
Model A is twice that of prosthesis Model B at three years, it will also be twice at four years, and so on.
This is referred to as the ‘proportional hazards assumption’. If the hazard ratio is not proportional over
the entire time of observation, then a time varying model is used, which estimates a separate hazard
ratio within each pre-defined time period. Within each time period, the hazards are proportional. The
Registry uses a set algorithm which iteratively chooses time points until the assumption of proportional
hazards is met for each time period. The time points are selected based on where the greatest
change in hazard occurs between the two comparison groups, weighted by the number of events in
that time period.
Cumulative Incidence Function: An estimator of the actual probability of revision in the presence of a
competing risk. In these circumstances, the Kaplan-Meier estimate, which treats competing risks as
censored, overestimates the true probability. In the competing risks paradigm, patients who have

a o a .o rg.a u 359
already had a revision or died are excluded from the set at risk of being revised. Under Kaplan-Meier
only patients who have already been revised are excluded from the risk set; dead patients are
analysed as though they are still at risk of revision.
Cumulative Percent Revision: Otherwise known as the ‘cumulative failure rate’. This is defined as 100 x
[1- S(t)] where S(t) is the survivorship probability estimated by the Kaplan-Meier method (see survival
curve, below). The cumulative percent revision gives the percent of procedures revised up until time t,
and allows for right censoring due to death (but see Cumulative Incidence Function above) or
closure of the database for analysis.
Hazard Ratio: A hazard is an estimate of the instantaneous risk of occurrence of an event, for
example revision, at a point in time, t. A hazard ratio results from dividing one group’s hazard by
another’s to give a comparative measure of the instantaneous risk of experiencing the event of
interest. In this report, hazard ratios are adjusted for age and gender as appropriate. Hazard ratios are
either for the entire survivorship period (if proportional; see ‘Cox Model or Proportional Hazards Model’
section above) or for specific time periods (if the hazard for the entire survivorship period is not
proportional).
For example, a comparison of Primary Total Conventional Hip Replacement for a Primary Diagnosis of
Avascular Necrosis (AVN), Developmental Dysplasia of the Hip (DDH) and Osteoarthritis (OA):
Avascular Necrosis vs Osteoarthritis.
Entire Period: HR=1.34 (1.16, 1.54), p<0.001
The hazard ratio for this comparison is proportional over the entire time of observation. AVN has a
significantly higher rate of event (in this case, revision) compared to OA over the entire time of
observation (p<0.001). The hazard is 1.34 times higher for AVN compared to OA and, with 95%
confidence, the true hazard for AVN will lie between 1.16 times higher and 1.54 times higher than the
hazard for OA.
0-3Mth: HR=1.75 (1.21, 2.52), p=0.002
3Mth+: HR=1.07 (0.78, 1.45), p=0.683
The hazard ratio is not proportional over the entire time of observation, so the hazard ratio has been
divided into two periods; the time from primary arthroplasty to three months following the primary and
three months following the primary to the end of observation. DDH has a significantly higher revision
rate compared to OA in the first three months following the primary (p=0.002). The hazard for revision
in the first three months is 1.75 times higher for DDH than for OA and with 95% confidence, the true
hazard for DDH will lie between 1.21 and 2.52 times higher. From three months following the primary to
the end of observation, there is no significant difference in the revision rate between DDH and OA
(p=0.683).
Incidence Rate: The number of new occurrences of an event divided by a measure of the population
at risk of that event over a specified time period. The population at risk is often given in terms of
person-time: for example, if 6 persons are each at risk over 4 months, they contribute 6 x 1/3 = 2
person-years to the denominator of the incidence rate. The incidence rate ratio (IRR) is commonly
used to compare the incidence rates of two groups. If the two groups incidence rates are the same,
an IRR of 1 results.
Log Rank Test: A family of statistical tests that compares the survival experience of two or more groups
over the entire time of observation (contrast with comparison of survival at a defined time, e.g. five-
year survival.)
Observed Component Years: For each procedure, component time is the time during which it is at risk
of being revised. This is calculated as the number of days from the date of the primary procedure until
either the date of revision, date of death or end of study (31/12/2016) whichever happens first. This is
then divided by 365.25 to obtain the number of ‘component years’. Each primary procedure then
contributes this calculated number of component years to the overall total component years for a
particular category of prosthesis.
For example:
A primary total hip procedure performed on 1/1/2016 was revised on 1/7/2016. Therefore, the number
of days that this procedure is at risk of being revised is 183 days. This prosthesis then contributes 0.5

(183/365.25) component years to the overall number of observed component years for the total hip
procedure category.
A patient with a primary procedure on 1/1/2016 died without being revised on 1/4/2016. This
procedure contributes 0.25 component years.
A primary procedure occurs on 1/1/2016 and has not been revised. This procedure contributes 1
component year (as observation time is censored at 31/12/2016).
Survival Curve: A plot of the proportion of subjects who have not yet experienced a defined event
(for example, death or revision of prosthesis) versus time. The Kaplan-Meier method is the one most
commonly used. The curve takes account of subjects whose ultimate survival time is not known, a
phenomenon called ‘censoring’. The survival estimate at each time is accompanied by a
confidence interval based on the method of Greenwood. An interval is interpretable only at the time
for which it was estimated and the sequence of intervals (depicted as shading on the Kaplan-Meier
curve) cannot be used to judge the significance of any perceived difference over the entire time of
observation. Often, for convenience, the curve is presented to show the proportion revised by a
certain time, rather than the proportion not being revised (‘surviving’). In the Registry, we call this
cumulative percent revision (CPR). The Kaplan-Meier method is biassed in the presence of a
competing risk and will overestimate the risk of revision. In such circumstances, use of the cumulative
incidence function for all competing risks, rather than the Kaplan-Meier estimate, is advised. The
cumulative incidence of all competing risks must be assessed simultaneously to avoid bias in
interpretation.
Funnel Plot: A funnel plot is a scatter plot where each point represents a single surgeon or single
hospital. The X (horizontal) axis represents volume: the total number of relevant surgical procedures
recorded by the Registry for each surgeon or hospital. The Y-axis is a measure of performance given
by the standardised proportion. This is calculated for each surgeon or hospital as the ratio of the
number of revisions observed to the number of revisions expected, multiplied by the overall
proportion of revisions. To calculate the expected number of revisions, a logistic regression model is
used to determine the probability of revision based on a patient’s age and gender. The sum of these
predicted values for each surgeon or hospital is the estimate of the expected number of revisions.

a o a .o rg.a u 361
APPENDIX 3
DIAGNOSIS HIERARCHY FOR REVISION HIP REPLACEMENT
Rank Diagnosis Category
1 Tumour Dominant diagnosis

independent of
2 Infection
prosthesis/surgery
3 Leg Length Discrepancy

4 Incorrect Sizing Surgical procedure
5 Malposition
6 Metal Related Pathology

7 Loosening Reaction to prosthesis
8 Lysis
9 Wear Hip Insert

10 Wear Acetabular Cup/Shell
11 Wear Head
12 Implant Breakage Head Wear and implant breakage
13 Implant Breakage Stem
14 Implant Breakage Hip Insert
15 Implant Breakage Acetabular Cup/Shell
16 Prosthesis Dislocation
Stability of prosthesis
17 Instability
Fracture
18 Fracture of bone
(Femur/Acetabular/Neck/Periprosthetic)
19 Chondrolysis/Acetabular Erosion Progression of disease on

20 Progression of Disease non-operated part of joint
21 Synovitis New diseases occurring in

22 Osteonecrosis/AVN association with joint
23 Heterotopic Bone replacement
24 Pain Pain
25 Other Remaining diagnoses

DIAGNOSIS HIERARCHY FOR REVISION KNEE REPLACEMENT

independent of
2 Infection
prosthesis/surgery
3 Incorrect Side
5 Malalignment

8 Lysis
9 Wear Knee Insert

10 Wear Tibial Tray
11 Wear Femoral
12 Wear Patella Wear and implant breakage
13 Implant Breakage Femoral
14 Implant Breakage Knee Insert
15 Implant Breakage Tibial Tray
16 Implant Breakage Patella
17 Bearing Dislocation
18 Patellar Dislocation
19 Prosthesis Dislocation Stability of prosthesis/knee
20 Instability
21 Patellar Maltracking
22 Fracture (Femur/Tibia/Patella/Periprosthetic) Fracture of bone
23 Progression of Disease Progression of disease on

24 Patellar Erosion non-operated part of joint
25 Synovitis
New diseases occurring in
26 Arthrofibrosis
association with joint
27 Osteonecrosis/AVN
replacement
28 Heterotopic Bone
29 Patellofemoral Pain
Pain
30 Pain

a o a .o rg.a u 363
DIAGNOSIS HIERARCHY FOR REVISION SHOULDER REPLACEMENT


independent of
2 Infection
prosthesis/surgery
3 Incorrect Side
5 Malposition

8 Lysis
9 Wear Glenoid Insert

10 Wear Glenoid
Wear and implant breakage
11 Wear Humeral
12 Implant Breakage Glenoid Insert
13 Implant Breakage Glenoid
14 Implant Breakage Humeral
15 Implant Breakage Head
16 Instability/ Dislocation
17 Rotator Cuff Insufficiency Stability of prosthesis
18 Dissociation
19 Fracture (Glenoid/Humeral/Periprosthetic) Fracture of bone
20 Progression of Disease Progression of disease on

21 Glenoid Erosion non-operated part of joint
22 Synovitis
New diseases occurring in
23 Arthrofibrosis
association with joint
24 Osteonecrosis/AVN
replacement
25 Heterotopic Bone
26 Pain Pain

APPENDIX 4
PATIENT CONSENT AND CONFIDENTIALITY GUIDELINES
PATIENT CONSENT
The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) obtains
consent to include information from individuals undergoing joint replacement by using the ‘opt off’
approach. The implementation of the new Commonwealth Legislation at the end of 2001 resulted in
the Registry meeting with the Privacy Commission to ensure that the system used for patient consent is
within the privacy guidelines.
Using this approach, patients are provided with a Patient Information Sheet. This explains what
information is required, how it is collected and the avenues to take should an individual not want their
information included in the Registry. The information is provided to patients by surgeons and hospitals
prior to surgery. To accommodate patients that may have questions, wish to opt off or discuss any
issues, a freecall number is available to contact the Registry.
PATIENT CONFIDENTIALITY
Joint replacement patients will not be contacted directly by the Registry. No individual patient will be
identified during analysis or in reports and publications produced by the Registry. Patient operative
and prostheses data is managed in accordance with the Guidelines for the Protection of Privacy in
the Conduct of Medical Research. Personal data collected are for use by the AOA National Joint
Replacement Registry only. The Registry has been listed as a Federal Quality Assurance Activity and
all information is protected (refer to section below).
DATA MANAGEMENT & CONFIDENTIALITY

The South Australian Health and Medical Research Institute (SAHMRI) undertakes data entry,
validation and analysis and provides secure data storage.
The list of personnel with access to identified Registry information is as follows:

Director, Professor Stephen Graves
Deputy Director, Professor Richard de Steiger
Deputy Director, Mr Peter Lewis
Deputy Director, Mr Ian Harris
Assistant Deputy Director, Mr James Stoney
Assistant Deputy Director, Bill Donnelly
Manager, Ms Cindy Turner
Research Coordinator, Dr Sophia Rainbird
Administration Assistant, Ms Rychelle Brittain
SAHMRI staff including the project manager, data managers, data assistants, statisticians
and programmers.
Declaration of the project as a Quality Assurance Activity ensures that Registry and SAHMRI staff are
bound to maintain confidentiality. Confidentiality not only applies to individual patients but also
includes surgeons and hospitals.
SAHMRI has security systems to restrict access to SAHMRI and Registry staff only. There are policies and
procedures in place as well as software barriers to protect personal information. These include the use
of codes, passwords and encryption.
The proforma used for data collection are stored in a secure locked room at SAHMRI. Forms are
scanned and electronically stored. After data entry and data cleaning, all data are securely stored
and retained in accordance with good scientific practice.

a o a .o rg.a u 365
SURGEON CONFIDENTIALITY
Surgeon confidentiality is assured. The purpose of the Registry is to provide demographic and
outcome information relevant to joint replacement surgery. Surgeon name is not recorded in the
Registry database.
It is an important Registry function to provide a service to surgeons that allows them to monitor and
audit their own performance. For this reason, surgeons have a choice to identify themselves by code,
which can be linked to their procedures. This is optional and there is no requirement to provide the
surgeon code. These codes are provided to surgeons by AOA.
Surgeons are provided with access to their own information through a secure internet facility. It is
important to emphasise that surgeons have the choice of using their code and that surgeon name is
not recorded in the database.
FEDERAL QUALITY ASSURANCE ACTIVITY

The AOANJRR was initially declared a Federal Quality Assurance Activity in March 1999, by the then
Federal Minister for Health and Aged Care, Dr Wooldridge. This was renewed in 2001, 2006, 2011 and
for a further five years in August 2017. An amendment was approved in 2017 to add collection of
Knee Osteotomy procedures. This declaration ensures freedom from subpoena and absolute
confidentiality of information held by the Registry.
The Quality Assurance legislation is part of the Health Insurance Act of 1973. This act was amended in
1992 to include quality assurance confidentiality. The Act operates on the underlying assumption that
quality assurance activities are in the public interest.
A declaration as a Quality Assurance Activity by the Commonwealth Minister of Health prohibits the
disclosure of information, which identifies individual patients or health care providers that is known
solely as a result of the declared quality assurance activity. It is not possible to provide identifying
information to any individual or organisation including the government.
The protection provided by the declaration assures surgeons, hospitals and government that
information supplied to the Registry remains confidential and secure. The act also protects persons
engaging in those activities in good faith from civil liability in respect of those activities.

APPENDIX 5
PATIENT INFORMATION
INTRODUCTION - about the Registry
You are about to have a joint replacement. This operation is very successful and most people do not require any further
surgery following this procedure. However, a number of people who have a joint replacement may at some time in the
future require another operation on that joint. This may occur due to a variety of reasons; the most common being that
the joint replacement has worn out. Furthermore, differences between the many types of artificial joints available may
affect the time at which they wear out and require replacing. In order to improve the success of this surgery, the Australian
Orthopaedic Association has set up a National Joint Replacement Registry so that joint replacement and prostheses can be
monitored.
The purpose of the Registry is to assess the performance of all joint replacement. If a joint replacement is identified as
having a problem, the Registry can assist hospitals to locate those people that may be affected. To do this it is important
to record information on every person having a joint replacement. More than 90,000 people have joint replacement
surgery each year in Australia. It is also important to record details on any subsequent operations and the reason the
surgery was performed. By analysing this information, it will be possible to identify the cause of any problems as well as
determine which types of joint replacement have the best results. To be successful, the Registry needs to gather
information on as many people having joint replacement surgery as possible. We are asking you to participate in the
Registry, by allowing us to document information relevant to your operation.
Your Involvement - the information we need

The information we require includes your name, date of birth, address, Medicare number, hospital identity number, the
name of the hospital and the reason you are having a joint replacement. This information is necessary to accurately link
you to the artificial joint inserted as well as linking any following joint surgery you may have, to your previous records. We
will also record the day of the operation, which joint was operated on and the type of artificial joint used. No other personal
information is recorded. Hospitals and Government will from time to time provide information that enables the Registry
to check the accuracy of its data.
Information - how we will keep your information confidential

Your personal information is confidential and cannot be used outside the Registry. Procedures are in place to protect your
information and to keep it confidential. When your details have been entered into the Registry your record will be given
a specific Registry number. In addition, you cannot be identified in any reports produced by the Registry.
How we will collect the information

Although we are asking to record your operation details in the Registry you are not required to do anything. Your surgeon
and/or theatre staff will complete the form that contains your personal details at the time of your operation and send it
to us. The information will be entered into the Registry computer.
Risks and Benefits - to you

There are no risks to you by having your details in the Registry. Your information is protected and we are not allowed to
identify you by law. The Registry produces general reports on a variety of factors that influence the success of joint
replacement surgery. This will improve the quality of future joint replacement surgery.
What to do if you don’t want to be in the Registry
We understand that not everyone is comfortable about having his or her personal details documented in a Registry. If you
feel this way and do not want your details recorded please contact Ms Cindy Turner, Manager, on 1800 068 419 (freecall)
as well as making your decision known to hospital staff. A decision on whether or not you wish to be involved in the
Registry does not affect your treatment in any way. If you have any questions, concerns or require further information on
the National Joint Replacement Registry please do not hesitate to contact Ms Cindy Turner.
Concerns or complaints related to the data collection process may be directed to the AOANJRR on 1800 068 419 (freecall)
or alternatively the Australian Government, Office of the Privacy Commissioner on 1300 363 992

a o a .o rg.a u 367
APPENDIX 6
IMPLEMENTATION OF NATIONAL JOINT REPLACEMENT REGISTRY FOR HIP, KNEE & SHOULDER
The Registry was implemented in a staged manner on a state-by-state basis. The table below shows
the commencement date for each state. Implementation was completed nationally by mid 2002,
therefore 2003 was the first year of complete national data. National data collection on shoulder
replacement commenced in November 2007.
State/Territory Commencement Date
South Australia September 1999
Queensland April 2000
Western Australia April 2000
Victoria July 2000
Tasmania September 2000
Northern Territory October 2000
Australian Capital Territory May 2001
New South Wales June 2001

APPENDIX 7
ICD-10-AM CODES
HIP REPLACEMENT
PARTIAL HIP REPLACEMENT

49315-00 Partial arthroplasty (excludes Austin-Moore)
47522-00 Austin-Moore
PRIMARY TOTAL HIP REPLACEMENT
49318-00 Total arthroplasty of hip unilateral
49319-00 Total arthroplasty of hip bilateral
90607-00 [1489] Resurfacing of hip, unilateral
90607-01 [1489] Resurfacing of hip, bilateral
REVISION HIP REPLACEMENT
49312-00 Excision arthroplasty of hip (removal of prosthesis without replacement)
49324-00 Revision of total arthroplasty of hip
49327-00 Revision of total arthroplasty with bone graft to acetabulum
49330-00 Revision of total arthroplasty with bone graft to femur
49333-00 Revision of total arthroplasty with bone graft to acetabulum and femur
49339-00 Revision of total arthroplasty of hip with anatomic specific allograft to acetabulum
49342-00 Revision of total arthroplasty of hip with anatomic specific allograft to femur
49345-00 Revision of total arthroplasty with anatomic specific allograft to acetabulum & femur
49346-00 Revision of partial arthroplasty hip replacement
KNEE REPLACEMENT
PARTIAL KNEE REPLACEMENT

Patellofemoral Knee Replacement
49534-01 Total replacement arthroplasty of patellofemoral joint of knee
Unicompartmental Knee Replacement
49517-00 Hemi arthroplasty of knee
49518-00 Total arthroplasty of knee unilateral
49519-00 Total arthroplasty of knee bilateral
49521-00 Total arthroplasty of knee with bone graft to femur unilateral
49521-01 Total arthroplasty of knee with bone graft to femur bilateral
49521-02 Total arthroplasty of knee with bone graft to tibia unilateral
49521-03 Total arthroplasty of knee with bone graft to tibia bilateral
49524-00 Total arthroplasty of knee with bone graft to femur and tibia unilateral
49524-01 Total arthroplasty of knee with bone graft to femur and tibia bilateral
REVISION KNEE REPLACEMENT
49512-00 Arthrodesis with removal of prosthesis
49515-00 Removal-prostheses from knee
49527-00 Revision of total arthroplasty of knee excluding patellar resurfacing
49530-00 Revision of total arthroplasty of knee with bone graft to femur
49530-01 Revision of total arthroplasty of knee with bone graft to tibia
49533-00 Revision of total arthroplasty of knee with bone graft to femur and tibia
49554-00 Revision of total arthroplasty of knee with anatomic specific allograft
90562-00 Patellar resurfacing
SHOULDER REPLACEMENT
PARTIAL SHOULDER REPLACEMENT

48915-00 Hemiarthroplasty of shoulder
TOTAL SHOULDER REPLACEMENT
48918-00 Total arthroplasty of shoulder
REVISION SHOULDER REPLACEMENT
48921-00 Revision of total joint replacement of shoulder
48924-00 Revision of total joint replacement of shoulder with bone graft
48927-00 Removal of shoulder prosthesis
48942-00 Arthrodesis and removal of shoulder prosthesis

a o a .o rg.a u 369
List of Tables
Surgeon and Hospital Variation ............................................................................................................................................................................... 19

Table SV1 Number of Surgeons within each Prosthesis Consistency Group.................................................................................................................... 24
Table SV2 CPR of Primary Total Conventional Hip Replacement by Prosthesis Consistency (Primary Diagnosis OA)...................................................... 25
Table SV3 Primary Total Conventional Hip Replacement by Prosthesis Consistency and Prosthesis Combination Used (Primary Diagnosis OA) .......... 26
Table SV4 CPR of Primary Conventional THR by Prosthesis Consistency, using the 10 Prosthesis Combinations with Lowest 5 Year CPR (OA) ............. 26
Table SV5 Number of Surgeons within each Prosthesis Consistency Group ................................................................................................................... 32
Table SV6 CPR of Primary Total Knee Replacement by Prosthesis Consistency (Primary Diagnosis OA) ......................................................................... 33
Table SV7 Primary Total Knee Replacement by Prosthesis Consistency and Prosthesis Used (Primary Diagnosis OA) ................................................... 34
Table SV8 CPR of Primary Total Knee Replacement by Prosthesis Consistency using the 10 Prosthesis Combinations with Lowest 5 Year CPR (OA) .... 34
Table SV9 CPR of Primary Total Conventional Hip Replacement by Hospital Type (Primary Diagnosis OA) .................................................................... 38
Table SV10 CPR of Primary Total Conventional Hip Replacement by Hospital Type (Primary Diagnosis Fractured NOF) ................................................ 39
Table SV11 CPR of Primary Conventional THR by Hospital Type using the 10 Prosthesis Combinations with Lowest 5 year CPR (OA) ........................... 40
Table SV12 CPR of Primary Conventional THR by Hospital Type using the 10 Prosthesis Combinations with Lowest 5 year CPR (Fractured NOF) ........ 41
Table SV13 CPR of Primary Total Knee Replacement by Hospital Type (Primary Diagnosis OA) ..................................................................................... 43
Table SV14 CPR of Primary Total Knee Replacement by Hospital Type using the 10 Prosthesis Combinations with Lowest 5 year CPR (OA) ................ 44
Ten and Fifteen Year Prosthesis Outcomes .............................................................................................................................................................. 45
Table TY1 CPR of Primary Total Conventional Hip Replacement Combinations with 10 Year Data (Primary Diagnosis OA) ........................................... 46
Table TY2 CPR of Primary Total Knee Replacement Combinations with 10 Year Data (Primary Diagnosis OA) ............................................................... 48
Table FY1 CPR of Primary Total Conventional Hip Replacement Combinations with 15 Year Data (Primary Diagnosis OA) ........................................... 50
Table FY2 CPR of Primary Total Knee Replacement Combinations with 15 Year Data (Primary Diagnosis OA) ............................................................... 51
Hip Replacement..................................................................................................................................................................................................... 53
Table H1 Number of Hip Replacements .......................................................................................................................................................................... 54
Table H2 ASA Score by Hip Category ............................................................................................................................................................................... 56
Table H3 BMI Category for Hip Replacement by Hip Category ........................................................................................................................................ 56
Primary Partial Hip Replacement ............................................................................................................................................................................. 57
Table HP1 Primary Partial Hip Replacement by Class ...................................................................................................................................................... 57
Table HP2 Cumulative Percent Mortality of Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF) .......................................... 58
Table HP3 CPR of Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF) ................................................................................... 58
Table HP4 CPR of Primary Partial Hip Replacement in Patients Aged <75 Years by Class (Primary Diagnosis Fractured NOF) ........................................ 59
Table HP5 Age and Gender of Primary Unipolar Monoblock Hip Replacement .............................................................................................................. 60
Table HP6 Most Used Monoblock Prostheses in Primary Unipolar Monoblock Hip Replacement .................................................................................. 60
Table HP7 CPR of Primary Unipolar Monoblock Hip Replacement (Primary Diagnosis Fractured NOF) .......................................................................... 61
Table HP8 Primary Unipolar Monoblock Hip Replacement by Reason for Revision (Primary Diagnosis Fractured NOF) ................................................ 62
Table HP9 Primary Unipolar Monoblock Hip Replacement by Type of Revision (Primary Diagnosis Fractured NOF)...................................................... 62
Table HP10 CPR of Primary Unipolar Monoblock Hip Replacement by Age (Primary Diagnosis Fractured NOF) ............................................................ 62
Table HP11 CPR of Primary Unipolar Monoblock Hip Replacement by Gender (Primary Diagnosis Fractured NOF) ...................................................... 63
Table HP12 CPR of Primary Unipolar Monoblock Hip Replacement by Femoral Fixation and Prosthesis Type (Primary Diagnosis Fractured NOF) ....... 64
Table HP13 Age and Gender of Primary Unipolar Modular Hip Replacement ................................................................................................................. 66
Table HP14 10 Most Used Unipolar Head Prostheses in Primary Unipolar Modular Hip Replacement .......................................................................... 67
Table HP15 10 Most Used Femoral Stem Prostheses in Primary Unipolar Modular Hip Replacement ........................................................................... 67
Table HP16 CPR of Primary Unipolar Modular Hip Replacement by Prosthesis Combination ......................................................................................... 68
Table HP17 CPR of Primary Unipolar Modular Hip Replacement (Primary Diagnosis Fractured NOF) ............................................................................ 69
Table HP18 Primary Unipolar Modular Hip Replacement by Reason for Revision (Primary Diagnosis Fractured NOF) .................................................. 70
Table HP19 Primary Unipolar Modular Hip Replacement by Type of Revision (Primary Diagnosis Fractured NOF) ........................................................ 70
Table HP20 CPR of Primary Unipolar Modular Hip Replacement by Age (Primary Diagnosis Fractured NOF)................................................................. 70
Table HP21 CPR of Primary Unipolar Modular Hip Replacement by Gender (Primary Diagnosis Fractured NOF) ........................................................... 71
Table HP22 CPR of Primary Unipolar Modular Hip Replacement by Femoral Fixation (Primary Diagnosis Fractured NOF) ............................................ 72
Table HP23 Age and Gender of Primary Bipolar Hip Replacement .................................................................................................................................. 73
Table HP24 10 Most Used Bipolar Head Prostheses in Primary Bipolar Hip Replacement .............................................................................................. 74
Table HP25 10 Most Used Femoral Stem Prostheses in Primary Bipolar Hip Replacement ............................................................................................ 74
Table HP26 CPR of Primary Bipolar Hip Replacement by Prosthesis Combination .......................................................................................................... 75
Table HP27 CPR of Primary Bipolar Hip Replacement (Primary Diagnosis Fractured NOF) ............................................................................................. 76
Table HP28 Primary Bipolar Hip Replacement by Reason for Revision ........................................................................................................................... 77
Table HP29 Primary Bipolar Hip Replacement by Type of Revision ................................................................................................................................. 77
Table HP30 CPR of Primary Bipolar Hip Replacement by Age (Primary Diagnosis Fractured NOF).................................................................................. 77
Table HP31 CPR of Primary Bipolar Hip Replacement by Gender (Primary Diagnosis Fractured NOF) ............................................................................ 78
Table HP32 CPR of Primary Bipolar Hip Replacement by Femoral Fixation (Primary Diagnosis Fractured NOF) ............................................................. 79
Primary Total Hip Replacement ............................................................................................................................................................................... 80
Table HT1 Primary Total Hip Replacement by Class ........................................................................................................................................................ 80
Table HT2 CPR of Primary Total Hip Replacement by Class ............................................................................................................................................. 80
Table HT3 Age and Gender of Primary Total Conventional Hip Replacement ................................................................................................................. 81
Table HT4 10 Most Used Femoral Components in Primary Total Conventional Hip Replacement .................................................................................. 82
Table HT5 10 Most Used Cemented Femoral Components in Primary Total Conventional Hip Replacement ................................................................ 82
Table HT6 10 Most Used Cementless Femoral Components in Primary Total Conventional Hip Replacement .............................................................. 83
Table HT7 10 Most Used Acetabular Components in Primary Total Conventional Hip Replacement ............................................................................. 83
Table HT8 10 Most Used Cemented Acetabular Components in Primary Total Conventional Hip Replacement ............................................................ 84

Table HT9 10 Most Used Cementless Acetabular Components in Primary Total Conventional Hip Replacement .......................................................... 84
Table HT10 CPR of Primary Total Conventional Hip Replacement by Primary Diagnosis ................................................................................................ 86
Table HT11 CPR of Primary Total Conventional Hip Replacement with Cemented Fixation ............................................................................................ 87
Table HT12 CPR of Primary Total Conventional Hip Replacement with Cementless Fixation .......................................................................................... 88
Table HT13 CPR of Primary Total Conventional Hip Replacement with Hybrid Fixation ................................................................................................. 90
Table HT14 CPR of Primary Total Conventional Hip Replacement (Primary Diagnosis OA) ............................................................................................. 92
Table HT15 Primary Total Conventional Hip Replacement by Reason for Revision (Primary Diagnosis OA) ................................................................... 93
Table HT16 Primary Total Conventional Hip Replacement by Type of Revision (Primary Diagnosis OA) ......................................................................... 93
Table HT17 CPR of Primary Total Conventional Hip Replacement by Age (Primary Diagnosis OA) ................................................................................. 94
Table HT18 CPR of Primary Total Conventional Hip Replacement by Gender and Age (Primary Diagnosis OA) .............................................................. 95
Table HT19 CPR of Primary Total Conventional Hip Replacement by Fixation (Primary Diagnosis OA) ........................................................................... 98
Table HT20 CPR of Primary Total Conventional Hip Replacement by Age and Fixation (Primary Diagnosis OA) ............................................................. 99
Table HT21 CPR of Primary Total Conventional Hip Replacement by Stem Type (Primary Diagnosis OA) ..................................................................... 102
Table HT22 Primary Total Conventional Hip Replacement by Type of Revision and Stem Type (Primary Diagnosis OA) .............................................. 103
Table HT23 CPR of Primary Total Conventional Hip Replacement using a Mini Stem by Femoral Stem (Primary Diagnosis OA) .................................. 103
Table HT24 CPR of Primary Total Conventional Hip Replacement by Type of Femoral Neck (Primary Diagnosis OA) ................................................... 104
Table HT25 Primary Total Conventional Hip Replacement by Reason for Revision and Type of Femoral Neck (Primary Diagnosis OA) ....................... 105
Table HT26 CPR of Primary Total Conventional Hip Replacement Using an Exchangeable Femoral Neck by Stem/Neck Metal Combination (OA) ..... 107
Table HT27 CPR of Primary Total Conventional Hip Replacement Using an Exchangeable Femoral Neck by Prosthesis Type (OA) .............................. 108
Table HT28 CPR of Primary Total Conventional Hip Replacement by Bearing Surface (Primary Diagnosis OA) ............................................................ 109
Table HT29 CPR of Primary Total Conventional Hip Replacement by Polyethylene Type and Head Size (Primary Diagnosis OA) ................................. 113
Table HT30 CPR of Primary Total Conventional Hip Replacement by Prosthesis Type and Polyethylene Type (Primary Diagnosis OA) ....................... 118
Table HT31 CPR of Primary Total Conventional Hip Replacement by Prosthesis Type and Polyethylene Type (Primary Diagnosis OA) ....................... 121
Table HT32 CPR of Mixed Ceramic/Mixed Ceramic Primary Total Conventional Hip Replacement by Head Size (Primary Diagnosis OA) .................... 123
Table HT33 Primary Total Conventional Hip Replacement by Primary Diagnosis and Acetabular Type ........................................................................ 126
Table HT34 CPR of Primary Total Conventional Hip Replacement by Acetabular Type (All Diagnoses)......................................................................... 127
Table HT35 CPR of Primary Total Conventional Hip Replacement by Acetabular Type (Primary Diagnosis OA) ........................................................... 128
Table HT36 CPR of Constrained Primary Total Conventional Hip Replacement by Gender (Primary Diagnosis OA) ..................................................... 129
Table HT37 CPR of Constrained Primary Total Conventional Hip Replacement by Age (Primary Diagnosis OA) ........................................................... 130
Table HT38 CPR of Constrained Primary Total Conventional Hip Replacement by Fixation (Primary Diagnosis OA)..................................................... 131
Table HT39 Primary Diagnosis of Primary Total Conventional Hip Replacement by Acetabular Mobility ..................................................................... 132
Table HT40 CPR of Primary Total Conventional Hip Replacement by Acetabular Mobility (All Diagnoses) ................................................................... 133
Table HT41 CPR of Primary Total Conventional Hip Replacement by Acetabular Mobility (Primary Diagnosis OA) ...................................................... 134
Table HT42 CPR of Primary Total Conventional Hip Replacement (Primary Diagnosis Fractured NOF) ......................................................................... 135
Table HT43 Primary Total Conventional Hip Replacement by Reason for Revision (Primary Diagnosis Fractured NOF) ............................................... 136
Table HT44 Primary Total Conventional Hip Replacement Hip Replacement by Type of Revision (Primary Diagnosis Fractured NOF) ........................ 136
Table HT45 CPR of Primary Total Conventional Hip Replacement by Fixation (Primary Diagnosis Fractured NOF) ...................................................... 137
Table HT46 CPR of Primary Total Conventional Hip Replacement by Age and Fixation (Primary Diagnosis Fractured NOF) ........................................ 138
Table HT47 CPR of Primary Total Conventional Hip Replacement by Head Size (Primary Diagnosis Fractured NOF).................................................... 140
Table HT48 CPR of Primary Total Conventional Hip Replacement by Acetabular Type (Primary Diagnosis Fractured NOF) ......................................... 141
Table HT49 CPR of Primary Total Conventional Hip Replacement by Acetabular Mobility (Primary Diagnosis Fractured NOF) ................................... 142
Table HT50 CPR of Primary Hip Replacement by Class (Primary Diagnosis Fractured NOF) .......................................................................................... 144
Table HT51 CPR of Primary Hip Replacement by Class and Age (Primary Diagnosis Fractured NOF) ............................................................................ 145
Table HT52 Cumulative Incidence Mortality of Primary Hip Replacement in Patients Aged <70 Years by Class (Fractured NOF)................................. 148
Table HT53 Cumulative Incidence Revision of Primary Hip Replacement in Patients Aged <70 Years by Class (Fractured NOF) .................................. 149
Table HT54 Cumulative Incidence Mortality of Primary Hip Replacement in Patients Aged ≥ 70 Years by Class (Fractured NOF) ................................ 150
Table HT55 Cumulative Incidence Revision of Primary Hip Replacement in Patients Aged ≥ 70 Years by Class (Fractured NOF) ................................. 151
Table HT56 Age and Gender of Primary Total Resurfacing Hip Replacement ............................................................................................................... 152
Table HT57 Most Used Resurfacing Heads in Primary Total Resurfacing Hip Replacement .......................................................................................... 153
Table HT58 CPR of Primary Total Resurfacing Hip Replacement by Primary Diagnosis ................................................................................................. 154
Table HT59 CPR of Primary Total Resurfacing Hip Replacement by Prosthesis Combination ........................................................................................ 155
Table HT60 CPR of Primary Total Resurfacing Hip Replacement (Primary Diagnosis OA).............................................................................................. 157
Table HT61 Primary Total Resurfacing Hip Replacement by Reason for Revision (Primary Diagnosis OA) .................................................................... 158
Table HT62 Primary Total Resurfacing Hip Replacement by Type of Revision (Primary Diagnosis OA) ......................................................................... 158
Table HT63 CPR of Primary Total Resurfacing Hip Replacement by Age (Primary Diagnosis OA) .................................................................................. 159
Table HT64 CPR of Primary Total Resurfacing Hip Replacement by Gender and Age (Primary Diagnosis OA) .............................................................. 160
Table HT65 CPR of Primary Total Resurfacing Hip Replacement by Head Size (Primary Diagnosis OA) ........................................................................ 162
Table HT66 CPR of Primary Total Resurfacing Hip Replacement by Gender and Head Size (Primary Diagnosis OA) ..................................................... 163
Knee Replacement .................................................................................................................................................................................................165
Table K1 Number of Knee Replacements ...................................................................................................................................................................... 166
Table K2 ASA Score by Knee Category ........................................................................................................................................................................... 168
Table K3 BMI Category for Knee Replacement by Knee Category ................................................................................................................................. 168
Primary Partial Knee Replacement .........................................................................................................................................................................169
Table KP1 Partial Knee Replacement by Class ............................................................................................................................................................... 169
Table KP2 CPR of Primary Partial Knee Replacement by Class ...................................................................................................................................... 169
Table KP3 Age and Gender of Primary Partial Resurfacing Knee Replacement ............................................................................................................. 170
Table KP4 CPR of Primary Partial Resurfacing Knee Replacement (Primary Diagnosis OA) ........................................................................................... 171
Table KP5 Age and Gender of Primary Patella/Trochlea Knee Replacement ................................................................................................................. 172
Table KP6 Most Used Resurfacing Trochlear Prostheses in Primary Patella/Trochlea Knee Replacement .................................................................... 172
Table KP7 CPR of Primary Patella/Trochlea Knee Replacement by Prosthesis Combination ......................................................................................... 173
Table KP8 Primary Patella/Trochlea Knee Replacement by Reason for Revision (Primary Diagnosis OA) ..................................................................... 174
Table KP9 Primary Patella/Trochlea Knee Replacement by Type of Revision (Primary Diagnosis OA) .......................................................................... 174

a o a .o rg.a u 371
Table KP10 CPR of Primary Patella/Trochlea Knee Replacement (Primary Diagnosis OA)............................................................................................. 175
Table KP11 CPR of Primary Patella/Trochlea Knee Replacement by Age (Primary Diagnosis OA) ................................................................................. 176
Table KP12 CPR of Primary Patella/Trochlea Knee Replacement by Gender (Primary Diagnosis OA) ........................................................................... 177
Table KP13 Age and Gender of Primary Unicompartmental Knee Replacement........................................................................................................... 178
Table KP14 10 Most Used Tibial Prostheses in Primary Unicompartmental Knee Replacement ................................................................................... 179
Table KP15 CPR of Primary Unicompartmental Knee Replacement by Prosthesis Combination ................................................................................... 180
Table KP16 CPR of Primary Unicompartmental Knee Replacement (Primary Diagnosis OA)......................................................................................... 181
Table KP17 Primary Unicompartmental Knee Replacement by Reason for Revision (Primary Diagnosis OA) ............................................................... 182
Table KP18 Primary Unicompartmental Knee Replacement by Type of Revision (Primary Diagnosis OA) .................................................................... 182
Table KP19 CPR of Primary Unicompartmental Knee Replacement by Age (Primary Diagnosis OA) ............................................................................. 183
Table KP20 CPR of Primary Unicompartmental Knee Replacement by Gender and Age (Primary Diagnosis OA) ......................................................... 184
Table KP21 CPR of Primary Unicompartmental Knee Replacement by Position (Primary Diagnosis OA) ...................................................................... 185
Table KP22 CPR of Lateral Primary Unicompartmental Knee Replacement by Prosthesis Combination (Primary Diagnosis OA) ................................. 185
Primary Total Knee Replacement ...........................................................................................................................................................................186
Table KT1 Age and Gender of Primary Total Knee Replacement ................................................................................................................................... 187
Table KT2 10 Most Used Femoral Prostheses in Primary Total Knee Replacement....................................................................................................... 189
Table KT3 10 Most Used Femoral Prostheses in Cemented Primary Total Knee Replacement ..................................................................................... 189
Table KT4 10 Most Used Femoral Prostheses in Cementless Primary Total Knee Replacement ................................................................................... 190
Table KT5 10 Most Used Femoral Prostheses in Hybrid Primary Total Knee Replacement ........................................................................................... 190
Table KT6 CPR of Primary Total Knee Replacement by Primary Diagnosis .................................................................................................................... 191
Table KT7 CPR of Cemented Primary Total Knee Replacement by Prosthesis Combination.......................................................................................... 192
Table KT8 CPR of Cementless Primary Total Knee Replacement by Prosthesis Combination ........................................................................................ 194
Table KT9 CPR of Hybrid Primary Total Knee Replacement by Prosthesis Combination ............................................................................................... 195
Table KT10 CPR of Primary Total Knee Replacement (Primary Diagnosis OA) ............................................................................................................... 197
Table KT11 Primary Total Knee Replacement by Reason for Revision (Primary Diagnosis OA) ..................................................................................... 198
Table KT12 Primary Total Knee Replacement by Type of Revision (Primary Diagnosis OA) .......................................................................................... 198
Table KT13 CPR of Primary Total Knee Replacement by Age (Primary Diagnosis OA) ................................................................................................... 199
Table KT14 CPR of Primary Total Knee Replacement by Gender and Age (Primary Diagnosis OA) ............................................................................... 200
Table KT15 CPR of Primary Total Knee Replacement by Bearing Mobility (Primary Diagnosis OA) ............................................................................... 204
Table KT16 CPR of Fixed Primary Total Knee Replacement by Bearing Type (Primary Diagnosis OA) ........................................................................... 205
Table KT17 CPR of Primary Total Knee Replacement by Stability (Primary Diagnosis OA) ............................................................................................ 207
Table KT18 CPR of Primary Total Knee Replacement with Medial Pivot by Insert (Primary Diagnosis OA) ................................................................... 208
Table KT19 CPR of Primary Total Knee Replacement by Stability (Primary Diagnosis OA, excluding Advance) ............................................................. 209
Table KT20 CPR of Primary Total Knee Replacement by Patella Usage (Primary Diagnosis OA) .................................................................................... 210
Table KT21 CPR of Primary Total Knee Replacement by Stability and Patella Usage (Primary Diagnosis OA) ............................................................... 211
Table KT22 CPR of Minimally Stabilised Primary Total Knee Replacement by Fixation (Primary Diagnosis OA) ............................................................ 213
Table KT23 CPR of Posterior Stabilised Primary Total Knee Replacement by Fixation (Primary Diagnosis OA) ............................................................. 214
Table KT24 CPR of Medial Pivot Primary Total Knee Replacement by Fixation (Primary Diagnosis OA) ........................................................................ 215
Table KT25 CPR of Primary Total Knee Replacement by Computer Navigation and Age (Primary Diagnosis OA) ......................................................... 216
Table KT26 CPR of Primary Total Knee Replacement since 2009 by IDI Usage (Primary Diagnosis OA) ........................................................................ 218
Table KT27 CPR of Primary Total Knee Replacement since 2009 by IDI Usage and Age (Primary Diagnosis OA) .......................................................... 219
Table KT28 CPR of Primary Total Knee Replacement by Polyethylene Type (Primary Diagnosis OA) ........................................................................... 221
Table KT29 CPR of Primary Total Knee Replacement by Polyethylene Type and Age (Primary Diagnosis OA) .............................................................. 223
Table KT30 CPR of Primary Total Knee Replacement by Prosthesis Combination and Polyethylene Type (Primary Diagnosis OA) .............................. 224
Table KT31 Hazard Ratios of XLPE vs Non XLPE in Primary Total Knee Replacement by Prosthesis Combination (Primary Diagnosis OA) ................... 225
Table KT32 CPR of XLPE Primary Total Knee Replacement by Polyethylene Type (Primary Diagnosis OA) ................................................................... 226
Shoulder Replacement ...........................................................................................................................................................................................229
Table S1 Number of Shoulder Replacements ................................................................................................................................................................ 230
Table S2 ASA Score by Shoulder Category ..................................................................................................................................................................... 232
Table S3 BMI Category for Shoulder Replacement by Shoulder Category..................................................................................................................... 232
Primary Partial Shoulder Replacement ...................................................................................................................................................................233
Table SP1 Primary Partial Shoulder Replacement by Class ............................................................................................................................................ 233
Table SP2 Primary Partial Shoulder Replacement by Gender and Class ........................................................................................................................ 234
Table SP3 Primary Partial Shoulder Replacement by Age and Class .............................................................................................................................. 234
Table SP4 Primary Partial Shoulder Replacement by Age and Gender .......................................................................................................................... 234
Table SP5 Primary Partial Shoulder Replacement by Primary Diagnosis and Gender ................................................................................................... 235
Table SP6 CPR of Primary Partial Shoulder Replacement by Class (All Diagnoses) ........................................................................................................ 235
Table SP7 CPR of Primary Partial Shoulder Replacement by Class (Primary Diagnosis OA) ........................................................................................... 236
Table SP8 Primary Partial Resurfacing Shoulder Replacement by Age and Gender ...................................................................................................... 237
Table SP9 Primary Partial Resurfacing Shoulder Replacement by Primary Diagnosis and Gender ................................................................................ 237
Table SP10 Primary Hemi Resurfacing Shoulder Replacement by Age and Gender ...................................................................................................... 238
Table SP11 Primary Hemi Resurfacing Shoulder Replacement by Primary Diagnosis and Gender ................................................................................ 238
Table SP12 Most Used Humeral Head Prostheses in Primary Hemi Resurfacing Shoulder Replacement...................................................................... 238
Table SP13 Primary Hemi Resurfacing Shoulder Replacement by Reason for Revision ................................................................................................. 240
Table SP14 Primary Hemi Resurfacing Shoulder Replacement by Type of Revision ...................................................................................................... 240
Table SP15 CPR of Primary Hemi Resurfacing Shoulder Replacement by Age (Primary Diagnosis OA) ......................................................................... 241
Table SP16 CPR of Primary Hemi Resurfacing Shoulder Replacement by Gender (Primary Diagnosis OA) ................................................................... 242
Table SP17 CPR of Primary Hemi Resurfacing Shoulder Replacement by Humeral Head (Primary Diagnosis OA) ........................................................ 242
Table SP18 Primary Hemi Mid Head Shoulder Replacement by Age and Gender ......................................................................................................... 243
Table SP19 Primary Hemi Mid Head Shoulder Replacement by Primary Diagnosis and Gender ................................................................................... 243
Table SP20 Primary Hemi Mid Head Shoulder Replacement by Reason for Revision .................................................................................................... 243
Table SP21 Primary Hemi Mid Head Shoulder Replacement by Type of Revision ......................................................................................................... 243

Table SP22 Primary Hemi Stemmed Shoulder Replacement by Age and Gender.......................................................................................................... 244
Table SP23 Primary Hemi Stemmed Shoulder Replacement by Primary Diagnosis and Gender ................................................................................... 244
Table SP24 10 Most Used Humeral Head Prostheses in Primary Hemi Stemmed Shoulder Replacement .................................................................... 245
Table SP25 10 Most Used Humeral Stem Prostheses in Primary Hemi Stemmed Shoulder Replacement .................................................................... 246
Table SP26 CPR of Primary Hemi Stemmed Shoulder Replacement by Primary Diagnosis ........................................................................................... 247
Table SP27 Primary Hemi Stemmed Shoulder Replacement by Reason for Revision and Primary Diagnosis ................................................................ 248
Table SP28 Primary Hemi Stemmed Shoulder Replacement by Type of Revision and Primary Diagnosis ..................................................................... 249
Table SP29 CPR of Primary Hemi Stemmed Shoulder Replacement by Age (Primary Diagnosis Fracture) .................................................................... 251
Table SP30 CPR of Primary Hemi Stemmed Shoulder Replacement by Gender (Primary Diagnosis Fracture) .............................................................. 252
Table SP31 CPR of Primary Hemi Stemmed Shoulder Replacement by Stem Type (Primary Diagnosis Fracture) ......................................................... 253
Table SP32 Yearly CPR of Primary Hemi Stemmed Shoulder Replacement by Stem Type and Humeral Fixation (Primary Diagnosis Fracture) ........... 254
Table SP33 CPR of Primary Hemi Stemmed Shoulder Replacement by Humeral Head and Stem (Primary Diagnosis Fracture) ................................... 255
Table SP34 CPR of Primary Hemi Stemmed Shoulder Replacement by Humeral Head and Fracture Stem (Primary Diagnosis Fracture) ..................... 255
Table SP35 CPR of Primary Hemi Stemmed Shoulder Replacement by Humeral Head and Non Fracture Stem (Primary Diagnosis Fracture) ............. 255
Table SP36 CPR of Primary Hemi Stemmed Shoulder Replacement by Age (Primary Diagnosis OA) ............................................................................ 256
Table SP37 CPR of Primary Hemi Stemmed Shoulder Replacement by Gender (Primary Diagnosis OA)....................................................................... 257
Table SP38 CPR of Primary Hemi Stemmed Shoulder Replacement by Humeral Head and Stem Prostheses (Primary Diagnosis OA) ......................... 258
Primary Total Shoulder Replacement .....................................................................................................................................................................259
Table ST1 Primary Total Shoulder Replacement by Class .............................................................................................................................................. 259
Table ST2 Primary Total Shoulder Replacement by Gender and Class .......................................................................................................................... 260
Table ST3 Primary Total Shoulder Replacement by Age and Class ................................................................................................................................ 260
Table ST4 Primary Total Shoulder Replacement by Age and Gender ............................................................................................................................ 260
Table ST5 Primary Total Shoulder Replacement by Primary Diagnosis and Gender ...................................................................................................... 261
Table ST6 CPR of Primary Total Shoulder Replacement by Class (All Prostheses) ......................................................................................................... 262
Table ST7 CPR of Primary Total Shoulder Replacement by Class (excluding SMR L2).................................................................................................... 263
Table ST8 Primary Total Resurfacing Shoulder Replacement by Age and Gender ......................................................................................................... 264
Table ST9 Primary Total Resurfacing Shoulder Replacement by Primary Diagnosis and Gender .................................................................................. 264
Table ST10 Most Used Humeral Head Prostheses in Primary Total Resurfacing Shoulder Replacement ...................................................................... 265
Table ST11 Most Used Glenoid Prostheses in Primary Total Resurfacing Shoulder Replacement................................................................................. 265
Table ST12 Primary Total Resurfacing Shoulder Replacement by Reason for Revision ................................................................................................. 265
Table ST13 Primary Total Resurfacing Shoulder Replacement by Type of Revision ...................................................................................................... 265
Table ST14 Primary Total Mid Head Shoulder Replacement by Age and Gender .......................................................................................................... 266
Table ST15 Primary Total Mid Head Shoulder Replacement by Primary Diagnosis and Gender ................................................................................... 266
Table ST16 Primary Total Mid Head Shoulder Replacement by Reason for Revision .................................................................................................... 267
Table ST17 Primary Total Mid Head Shoulder Replacement by Type of Revision ......................................................................................................... 267
Table ST18 Most Used Humeral Stem Prostheses in Primary Total Mid Head Shoulder Replacement ......................................................................... 267
Table ST19 Most Used Glenoid Prostheses in Primary Total Mid Head Shoulder Replacement.................................................................................... 267
Table ST20 Primary Total Conventional Shoulder Replacement by Age and Gender .................................................................................................... 268
Table ST21 Primary Total Conventional Shoulder Replacement by Primary Diagnosis and Gender .............................................................................. 269
Table ST22 10 Most Used Humeral Stem Prostheses in Primary Total Conventional Shoulder Replacement ............................................................... 270
Table ST23 10 Most Used Glenoid Prostheses in Primary Total Conventional Shoulder Replacement ......................................................................... 270
Table ST24 CPR of Primary Total Conventional Shoulder Replacement by Primary Diagnosis ...................................................................................... 272
Table ST25 Primary Total Conventional Shoulder Replacement by Reason for Revision............................................................................................... 273
Table ST26 Primary Total Conventional Shoulder Replacement by Type of Revision .................................................................................................... 273
Table ST27 CPR of Primary Total Conventional Shoulder Replacement by Age (Primary Diagnosis OA) ....................................................................... 275
Table ST28 CPR of Primary Total Conventional Shoulder Replacement by Gender (Primary Diagnosis OA) ................................................................. 276
Table ST29 CPR of Primary Total Conventional Shoulder Replacement by Fixation (Primary Diagnosis OA)................................................................. 277
Table ST30 CPR of Primary Total Conventional Shoulder Replacement by Fixation (Primary Diagnosis OA, excluding SMR L2) ................................... 278
Table ST31 CPR of Primary Total Conventional Shoulder Replacement by Glenoid Type (Primary Diagnosis OA) ........................................................ 279
Table ST32 CPR of Primary Total Conventional Shoulder Replacement by Glenoid Type (Primary Diagnosis OA, excluding SMR L2) .......................... 280
Table ST33 CPR of All Polyethylene Cemented Primary Total Conventional Shoulder Replacement by Glenoid Design (Primary Diagnosis OA) ......... 281
Table ST34 CPR of Primary Total Conventional Shoulder Replacement using All Types of Glenoid by Polyethylene Type (Primary Diagnosis OA) ...... 282
Table ST35 CPR of Primary Total Conventional Shoulder Replacement using All Polyethylene Glenoids by Polyethylene Type (OA) .......................... 283
Table ST36 CPR of Primary Total Conventional Shoulder Replacement by Humeral Head Size (Primary Diagnosis OA) ............................................... 284
Table ST37 CPR of All Primary Total Conventional Shoulder Replacement by Prosthesis Combination (Primary Diagnosis OA) .................................. 286
Table ST38 CPR of Cementless Primary Total Conventional Shoulder Replacement by Prosthesis Combination (Primary Diagnosis OA) .................... 286
Table ST39 CPR of Hybrid (Glenoid Cemented) Primary Total Conventional Shoulder Replacement by Prosthesis Combination (OA) ........................ 287
Table ST40 Primary Total Reverse Shoulder Replacement by Age and Gender ............................................................................................................. 288
Table ST41 Primary Total Reverse Shoulder Replacement by Primary Diagnosis and Gender ...................................................................................... 289
Table ST42 10 Most Used Humeral Stem Prostheses in Primary Total Reverse Shoulder Replacement ....................................................................... 290
Table ST43 10 Most Used Glenoid Prostheses in Primary Total Reverse Shoulder Replacement .................................................................................. 290
Table ST44 CPR of Primary Total Reverse Shoulder Replacement by Primary Diagnosis ............................................................................................... 291
Table ST45 Primary Total Reverse Shoulder Replacement by Reason for Revision ....................................................................................................... 292
Table ST46 Primary Total Reverse Shoulder Replacement by Type of Revision ............................................................................................................ 292
Table ST47 CPR of Primary Total Reverse Shoulder Replacement by Age (Primary Diagnosis OA)................................................................................ 294
Table ST48 CPR of Primary Total Reverse Shoulder Replacement by Gender (Primary Diagnosis OA) .......................................................................... 295
Table ST49 CPR of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis OA) ......................................................................... 296
Table ST50 CPR of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis OA, excluding SMR L2) ........................................... 297
Table ST51 CPR of Primary Total Reverse Shoulder Replacement by Glenosphere Size (Primary Diagnosis OA) .......................................................... 298
Table ST52 CPR of All Primary Total Reverse Shoulder Replacement by Prosthesis Combination (Primary Diagnosis OA) ........................................... 300
Table ST53 CPR of Cementless Primary Total Reverse Shoulder Replacement by Prosthesis Combination (Primary Diagnosis OA) ............................. 301
Table ST54 CPR of Hybrid (Humerus Cemented) Primary Total Reverse Shoulder Replacement by Prosthesis Combination (OA)............................... 301

a o a .o rg.a u 373
Table ST55 CPR of Primary Total Reverse Shoulder Replacement by Age (Primary Diagnosis Rotator Cuff Arthropathy) ............................................ 302
Table ST56 CPR of Primary Total Reverse Shoulder Replacement by Gender (Primary Diagnosis Rotator Cuff Arthropathy) ....................................... 303
Table ST57 CPR of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis Rotator Cuff Arthropathy) ...................................... 304
Table ST58 CPR of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis Rotator Cuff Arthropathy, excluding SMR L2) ........ 305
Table ST59 CPR of Primary Total Reverse Shoulder Replacement by Glenosphere Size (Primary Diagnosis Rotator Cuff Arthropathy) ....................... 306
Table ST60 CPR of Primary Total Reverse Shoulder Replacement by Prosthesis Combination (Primary Diagnosis Rotator Cuff Arthropathy) ............. 308
Table ST61 CPR of Cementless Primary Total Reverse Shoulder Replacement by Prosthesis Combination (Rotator Cuff Arthropathy) ....................... 308
Table ST62 CPR of Hybrid (Humerus Cemented) Primary Total Reverse Shoulder Replacement by Prosthesis Combination (RCA) ........................... 308
Table ST63 CPR of Primary Total Reverse Shoulder Replacement by Age (Primary Diagnosis Fracture) ....................................................................... 310
Table ST64 CPR of Primary Total Reverse Shoulder Replacement by Gender (Primary Diagnosis Fracture) ................................................................. 311
Table ST65 CPR of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis Fracture) ................................................................ 312
Table ST66 CPR of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis Fracture, excluding SMR L2) ................................... 313
Table ST67 CPR of Primary Total Reverse Shoulder Replacement by Glenosphere Size (Primary Diagnosis Fracture) .................................................. 314
Table ST68 Revision Diagnosis of Primary Total Reverse Shoulder Replacement by Glenosphere Size (Primary Diagnosis Fracture)........................... 315
Table ST69 CPR of Primary Total Reverse Shoulder Replacement by Prosthesis Combination (Primary Diagnosis Fracture) ....................................... 317
Table ST70 CPR of Cementless Primary Total Reverse Shoulder Replacement by Prosthesis Combination (Primary Diagnosis Fracture) .................... 317
Table ST71 CPR of Hybrid (Humerus Cemented) Primary Total Reverse Shoulder Replacement by Prosthesis Combination (Fracture) ...................... 317
Prostheses with Higher Than Anticipated Rates of Revision ....................................................................................................................................319
Table IP1 Revision Rate of Individual Unipolar Modular Hip Prostheses Identified as having a Higher than Anticipated Rate of Revision ................... 321
Table IP2 CPR of Individual Unipolar Modular Hip Prostheses Identified as having a Higher than Anticipated Rate of Revision .................................. 321
Table IP3 Yearly Usage of Individual Unipolar Modular Hip Prostheses Identified as having a Higher than Anticipated Rate of Revision .................... 321
Table IP4 Revision Rate of Individual Bipolar Hip Prostheses Identified as having a Higher than Anticipated Rate of Revision .................................... 323
Table IP5 CPR of Individual Bipolar Hip Prostheses Identified as having a Higher than Anticipated Rate of Revision ................................................... 323
Table IP6 Yearly Usage of Individual Bipolar Hip Prostheses Identified as having a Higher than Anticipated Rate of Revision ..................................... 323
Table IP7 Revision Rate of Individual Total Conventional Hip Prostheses Identified as having a Higher than Anticipated Rate of Revision ................. 326
Table IP8 CPR of Individual Total Conventional Hip Prostheses Identified as having a Higher than Anticipated Rate of Revision ................................ 328
Table IP9 Yearly Usage of Individual Total Conventional Hip Prostheses Identified as having a Higher than Anticipated Rate of Revision .................. 330
Table IP10 Revision Rate of Individual Total Resurfacing Hip Prostheses Identified as having a Higher than Anticipated Rate of Revision.................. 337
Table IP11 CPR of Individual Total Resurfacing Hip Prostheses Identified as having a Higher than Anticipated Rate of Revision ................................. 338
Table IP12 Yearly Usage of Individual Total Resurfacing Hip Prostheses Identified as having a Higher than Anticipated Rate of Revision ................... 338
Table IP13 Revision Rate of Individual Patella/Trochlear Knee Prostheses Identified as having a Higher than Anticipated Rate of Revision ............... 339
Table IP14 CPR of Individual Patella/Trochlear Knee Prostheses Identified as having a Higher than Anticipated Rate of Revision .............................. 339
Table IP15 Yearly Usage of Individual Patella/Trochlear Knee Prostheses Identified as having a Higher than Anticipated Rate of Revision ................ 339
Table IP16 Revision Rate of Individual Unicompartmental Knee Prostheses Identified as having a Higher than Anticipated Rate of Revision ............ 340
Table IP17 CPR of Individual Unicompartmental Knee Prostheses Identified as having a Higher than Anticipated Rate of Revision ........................... 340
Table IP18 Yearly Usage of Individual Unicompartmental Knee Prostheses Identified as having a Higher than Anticipated Rate of Revision ............. 340
Table IP19 Revision Rate of Individual Total Knee Prostheses Identified as having a Higher than Anticipated Rate of Revision .................................. 342
Table IP20 CPR of Individual Total Knee Prostheses Identified as having a Higher than Anticipated Rate of Revision.................................................. 344
Table IP21 Yearly Usage of Individual Total Knee Prostheses Identified as having a Higher than Anticipated Rate of Revision ................................... 345
Table IP22 Revision Rate of Individual Hemi Stemmed Shoulder Prostheses Identified as having a Higher than Anticipated Rate of Revision ........... 349
Table IP23 CPR of Individual Hemi Stemmed Shoulder Prostheses Identified as having a Higher than Anticipated Rate of Revision ........................... 349
Table IP24 Yearly Usage of Individual Hemi Stemmed Shoulder Prostheses Identified as having a Higher than Anticipated Rate of Revision............. 349
Table IP25 Revision Rate of Individual Total Conventional Shoulder Prostheses Identified as having a Higher than Anticipated Rate of Revision ...... 350
Table IP26 CPR of Individual Total Conventional Shoulder Prostheses Identified as having a Higher than Anticipated Rate of Revision ..................... 350
Table IP27 Yearly Usage of Individual Total Conventional Shoulder Prostheses Identified as having a Higher than Anticipated Rate of Revision ....... 350
Table IP28 Revision Rate of Individual Total Reverse Shoulder Prostheses Identified as having a Higher than Anticipated Rate of Revision............... 352
Table IP29 CPR of Individual Total Reverse Shoulder Prostheses Identified as having a Higher than Anticipated Rate of Revision .............................. 352
Table IP30 Yearly Usage of Individual Total Reverse Shoulder Prostheses Identified as having a Higher than Anticipated Rate of Revision................ 352
Table IP31 Revision Rate of Individual Total Ankle Prostheses Identified as having a Higher than Anticipated Rate of Revision ................................. 353
Table IP32 CPR of Individual Total Ankle Prostheses Identified as having a Higher than Anticipated Rate of Revision ................................................. 353
Table IP33 Yearly Usage of Individual Total Ankle Prostheses Identified as having a Higher than Anticipated Rate of Revision .................................. 353

List of Figures
Surgeon and Hospital Variation ............................................................................................................................................................................... 19
Figure SV1 Funnel Plot of Primary Total Conventional Hip Replacement by Surgeon (Primary Diagnosis OA, Revision for Any Reason) ....................... 20
Figure SV2 Funnel Plot of Primary Conventional THR by Surgeon (OA, Excluding Large Head (>32mm) Metal/Metal, Revision for Any Reason) .......... 20
Figure SV3 Funnel Plot of Primary Conventional THR by Surgeon performed from 1 January 2008 (OA, Revision for Any Reason) ............................... 21
Figure SV4 Funnel Plot of Primary Total Conventional Hip Replacement by Surgeon (OA, Revision for Any Reason Within 2 Years) ............................. 21
Figure SV5 Funnel Plot of Primary Total Conventional Hip Replacement by Surgeon (OA, Revision for Prosthesis Dislocation Within 2 Years) ............ 22
Figure SV6 Funnel Plot of Primary Total Conventional Hip Replacement by Surgeon (Primary Diagnosis OA, Revision for Infection Within 2 Years) .... 22
Figure SV7 Funnel Plot of Primary Total Conventional Hip Replacement by Surgeon (Primary Diagnosis OA, Revision for Fracture Within 2 Years) .... 23
Figure SV8 Funnel Plot of Primary Total Conventional Hip Replacement by Surgeon (Primary Diagnosis OA, Revision for Loosening Within 2 Years) .. 23
Figure SV9 CPR of Primary Total Conventional Hip Replacement by Prosthesis Consistency (Prosthesis Combinations) (Primary Diagnosis OA) .......... 25
Figure SV10 CPR of Primary Conventional THR by Prosthesis Consistency using the 10 Prosthesis Combinations with Lowest 5 Year CPR (OA) ........... 26
Figure SV11 Funnel Plot of Primary Conventional THR by Surgeon (OA, Revision for Any Reason, 10 Prosthesis Combinations with Lowest 5Yr CPR) . 27
Figure SV12 Funnel Plot of Primary Conventional THR by Surgeon (OA, Revision for Any Reason, Excl 10 Combinations with Lowest 5Yr CPR) ........... 27
Figure SV13 Funnel Plot of Primary Total Knee Replacement by Surgeon (Primary Diagnosis OA, Revision for Any Reason) ......................................... 28
Figure SV14 Funnel Plot of Primary Total Knee Replacement by Surgeon performed from 1 January 2008 (OA, Revision for Any Reason)................... 29
Figure SV15 Funnel Plot of Primary Total Knee Replacement by Surgeon (Primary Diagnosis OA, Revision for Any Reason Within 2 Years) ................. 29
Figure SV16 Funnel Plot of Primary Total Knee Replacement by Surgeon (Primary Diagnosis OA, Revision for Infection Within 2 Years) ..................... 30
Figure SV17 Funnel Plot of Primary Total Knee Replacement by Surgeon (Primary Diagnosis OA, Revision for Loosening Within 2 Years) ................... 30
Figure SV18 Funnel Plot of Primary Total Knee Replacement by Surgeon (Primary Diagnosis OA, Revision for Patellofemoral Pain Within 2 Years) .... 31
Figure SV19 Funnel Plot of Primary Total Knee Replacement by Surgeon (Primary Diagnosis OA, Revision for Pain Within 2 Years) ............................ 31
Figure SV20 CPR of Primary Total Knee Replacement by Prosthesis Consistency (Primary Diagnosis OA) ...................................................................... 33
Figure SV21 CPR of Primary Total Knee Replacement by Prosthesis Consistency, 10 Prosthesis Combinations with Lowest 5 Year CPR (OA) ............... 34
Figure SV22 Funnel Plot of Primary TKR by Surgeon (OA, Revision for Any Reason, Excl 10 Combinations with Lowest 5Yr CPR).................................. 35
Figure SV23 Funnel Plot of Primary TKR by Surgeon (OA, Revision for Any Reason, 10 Prosthesis Combinations with Lowest 5 Year CPR) ................... 35
Figure SV24 Funnel plot of Primary Total Conventional Hip Replacement by Hospital (Primary Diagnosis OA, Revision for Any Reason) ..................... 37
Figure SV25 CPR of Primary Total Conventional Hip Replacement by Hospital Type (Primary Diagnosis OA) ................................................................. 38
Figure SV26 CPR of Primary Total Conventional Hip Replacement by Hospital Type (Primary Diagnosis Fractured NOF) .............................................. 39
Figure SV27 CPR of Primary Total Conventional Hip Replacement by Hospital Type, 10 Prosthesis Combinations with Lowest 5Yr CPR (OA)............... 40
Figure SV28 CPR of Primary Conventional THR by Hospital Type using the 10 Prosthesis Combinations with Lowest 5Yr CPR (Fractured NOF)............ 41
Figure SV29 Funnel plot of Primary Total Knee Replacement by Hospital (Primary Diagnosis OA, Revision for Any Reason) ......................................... 42
Figure SV30 CPR of Primary Total Knee Replacement by Hospital Type (Primary Diagnosis OA) .................................................................................... 43
Figure SV31 CPR of Primary Total Knee Replacement by Hospital Type using the 10 Prosthesis Combinations with Lowest 5 year CPR (OA) ............... 44
Ten and Fifteen Year Prosthesis Outcomes .............................................................................................................................................................. 45
Hip Replacement..................................................................................................................................................................................................... 53
Figure H1 Proportion of Hip Replacement ...................................................................................................................................................................... 54
Figure H2 BMI Distribution by Gender and Hip Category ................................................................................................................................................ 56
Primary Partial Hip Replacement ............................................................................................................................................................................. 57
Figure HP1 Primary Partial Hip Replacement by Class ..................................................................................................................................................... 57
Figure HP2 CPR of Primary Partial Hip Replacement by Class (Primary Diagnosis Fractured NOF) ................................................................................. 58
Figure HP3 CPR of Primary Partial Hip Replacement in Patients Aged <75 Years by Class (Primary Diagnosis Fractured NOF) ...................................... 59
Figure HP4 Primary Unipolar Monoblock Hip Replacement by Gender .......................................................................................................................... 60
Figure HP5 Primary Unipolar Monoblock Hip Replacement by Age ................................................................................................................................ 60
Figure HP6 CPR of Primary Unipolar Monoblock Hip Replacement (Primary Diagnosis Fractured NOF) ......................................................................... 61
Figure HP7 CPR of Primary Unipolar Monoblock Hip Replacement by Age (Primary Diagnosis Fractured NOF) ............................................................. 62
Figure HP8 CPR of Primary Unipolar Monoblock Hip Replacement by Gender (Primary Diagnosis Fractured NOF) ....................................................... 63
Figure HP9 CPR of Primary Unipolar Monoblock Hip Replacement by Femoral Fixation (Primary Diagnosis Fractured NOF) ........................................ 64
Figure HP10 CPR of Primary Unipolar Monoblock Hip Replacement by Prosthesis Type and Femoral Fixation (Primary Diagnosis Fractured NOF) ...... 65
Figure HP11 Primary Unipolar Modular Hip Replacement by Gender ............................................................................................................................. 66
Figure HP12 Primary Unipolar Modular Hip Replacement by Age .................................................................................................................................. 66
Figure HP13 CPR of Primary Unipolar Modular Hip Replacement (Primary Diagnosis Fractured NOF) ........................................................................... 69
Figure HP14 CPR of Primary Unipolar Modular Hip Replacement by Age (Primary Diagnosis Fractured NOF) ............................................................... 70
Figure HP15 CPR of Primary Unipolar Modular Hip Replacement by Gender (Primary Diagnosis Fractured NOF) ......................................................... 71
Figure HP16 CPR of Primary Unipolar Modular Hip Replacement by Femoral Fixation (Primary Diagnosis Fractured NOF) ........................................... 72
Figure HP17 Cumulative Incidence Revision Diagnosis of Primary Unipolar Modular Hip Replacement by Femoral Fixation (Fractured NOF) .............. 72
Figure HP18 Primary Bipolar Hip Replacement by Gender .............................................................................................................................................. 73
Figure HP19 Primary Bipolar Hip Replacement by Age ................................................................................................................................................... 73
Figure HP20 CPR of Primary Bipolar Hip Replacement (Primary Diagnosis Fractured NOF) ............................................................................................ 76
Figure HP21 CPR of Primary Bipolar Hip Replacement by Age (Primary Diagnosis Fractured NOF) ................................................................................ 77
Figure HP22 CPR of Primary Bipolar Hip Replacement by Gender (Primary Diagnosis Fractured NOF)........................................................................... 78
Figure HP23 CPR of Primary Bipolar Hip Replacement by Femoral Fixation (Primary Diagnosis Fractured NOF) ............................................................ 79
Figure HP24 Cumulative Incidence Revision Diagnosis of Primary Bipolar Hip Replacement by Femoral Fixation (Fractured NOF) ............................... 79
Primary Total Hip Replacement ............................................................................................................................................................................... 80
Figure HT1 Primary Total Conventional Hip Replacement by Gender ............................................................................................................................. 81
Figure HT2 Primary Total Conventional Hip Replacement by Age ................................................................................................................................... 81
Figure HT3 Primary Total Conventional Hip Replacement by Fixation ............................................................................................................................ 81
Figure HT4 CPR of Primary Total Conventional Hip Replacement by Primary Diagnosis ................................................................................................. 86
Figure HT5 CPR of Primary Total Conventional Hip Replacement (Primary Diagnosis OA) .............................................................................................. 92
Figure HT6 Cumulative Incidence Revision Diagnosis of Primary Total Conventional Hip Replacement (Primary Diagnosis OA) ................................... 93

a o a .o rg.a u 375
Figure HT7 CPR of Primary Total Conventional Hip Replacement by Age (Primary Diagnosis OA) ................................................................................. 94
Figure HT8 CPR of Primary Total Conventional Hip Replacement by Gender (Primary Diagnosis OA) ............................................................................ 95
Figure HT9 CPR of Primary Total Conventional Hip Replacement in Males by Age (Primary Diagnosis OA) ................................................................... 96
Figure HT10 CPR of Primary Total Conventional Hip Replacement in Females by Age (Primary Diagnosis OA) .............................................................. 96
Figure HT11 CPR of Primary Total Conventional Hip Replacement by Fixation (Primary Diagnosis OA).......................................................................... 98
Figure HT12 CPR of Primary Total Conventional Hip Replacement in Patients Aged <55 Years by Fixation (Primary Diagnosis OA) .............................. 99
Figure HT13 CPR of Primary Total Conventional Hip Replacement in Patients Aged 55-64 Years by Fixation (Primary Diagnosis OA) ......................... 100
Figure HT14 CPR of Primary Total Conventional Hip Replacement in Patients Aged 65-74 Years by Fixation (Primary Diagnosis OA) ......................... 100
Figure HT15 CPR of Primary Total Conventional Hip Replacement in Patients Aged ≥75 Years by Fixation (Primary Diagnosis OA) ............................ 101
Figure HT16 CPR of Primary Total Conventional Hip Replacement by Stem Type (Primary Diagnosis OA) ................................................................... 102
Figure HT17 Cumulative Incidence Revision Diagnosis of Primary Total Conventional Hip Replacement by Stem Type (Primary Diagnosis OA) ......... 102
Figure HT18 CPR of Primary Total Conventional Hip Replacement by Type of Femoral Neck (Primary Diagnosis OA) ................................................. 104
Figure HT19 Cumulative Incidence Revision Diagnosis of Primary Total Conventional Hip Replacement by Type of Femoral Neck (OA)..................... 105
Figure HT20 CPR of Primary Total Conventional Hip Replacement by Bearing Surface and Type of Femoral Neck (Primary Diagnosis OA) ................. 106
Figure HT21 CPR of Primary Total Conventional Hip Replacement Using an Exchangeable Femoral Neck by Stem/Neck Metal Combination (OA) .... 107
Figure HT22 Cumulative Incidence Revision Diagnosis of Primary Conventional THR Using an Exch Neck by Stem/Neck Metal Combination (OA) .... 108
Figure HT23 CPR of Primary Total Conventional Hip Replacement by Bearing Surface (Primary Diagnosis OA) ........................................................... 110
Figure HT24 Primary Total Conventional Hip Replacement by Polyethylene Type (Primary Diagnosis OA) .................................................................. 111
Figure HT25 CPR of Primary Total Conventional Hip Replacement by Polyethylene Type (Primary Diagnosis OA) ....................................................... 113
Figure HT26 Cumulative Incidence Revision Diagnosis of Primary Total Conventional Hip Replacement by Polyethylene Type (OA) .......................... 114
Figure HT27 CPR of Primary Total Conventional Hip Replacement using Non XLPE by Head Size (Primary Diagnosis OA) ........................................... 114
Figure HT28 CPR of Primary Total Conventional Hip Replacement using XLPE by Head Size (Primary Diagnosis OA) ................................................... 115
Figure HT29 Cumulative Incidence Revision Diagnosis of Primary Total Conventional Hip Replacement by Polyethylene Type and Head Size (OA) ... 116
Figure HT30 CPR of Primary Total Conventional Hip Replacement by Head Surface and Polyethylene Type (Primary Diagnosis OA) .......................... 117
Figure HT31 CPR of Allofit Primary Total Conventional Hip Replacement by Polyethylene Type (Primary Diagnosis OA) ............................................ 118
Figure HT32 CPR of Duraloc Primary Total Conventional Hip Replacement by Polyethylene Type (Primary Diagnosis OA) .......................................... 119
Figure HT33 CPR of Mallory-Head Primary Total Conventional Hip Replacement by Polyethylene Type (Primary Diagnosis OA) ................................ 119
Figure HT34 CPR of Reflection (Cup) Primary Total Conventional Hip Replacement by Polyethylene Type (Primary Diagnosis OA) ............................ 120
Figure HT35 CPR of Reflection (Shell) Primary Total Conventional Hip Replacement by Polyethylene Type (Primary Diagnosis OA) ........................... 120
Figure HT36 CPR of Vitalock Primary Total Conventional Hip Replacement by Polyethylene Type (Primary Diagnosis OA) ......................................... 121
Figure HT37 Primary Total Conventional Hip Replacement with Ceramic Femoral Head by Ceramic Type (Primary Diagnosis OA) ............................. 122
Figure HT38 CPR of Mixed Ceramic/Mixed Ceramic Primary Total Conventional Hip Replacement by Head Size (Primary Diagnosis OA) ................... 123
Figure HT39 Cumulative Incidence Revision Diagnosis of Mixed Ceramic/Mixed Ceramic Primary Conventional THR by Head Size (OA).................... 124
Figure HT40 CPR of Primary Total Conventional Hip Replacement by Acetabular Type (All Diagnoses) ....................................................................... 127
Figure HT41 CPR of Primary Total Conventional Hip Replacement by Acetabular Type (Primary Diagnosis OA) .......................................................... 128
Figure HT42 CPR of Constrained Primary Total Conventional Hip Replacement by Gender (Primary Diagnosis OA) .................................................... 129
Figure HT43 CPR of Constrained Primary Total Conventional Hip Replacement by Age (Primary Diagnosis OA) .......................................................... 130
Figure HT44 CPR of Constrained Primary Total Conventional Hip Replacement by Fixation (Primary Diagnosis OA) ................................................... 131
Figure HT45 CPR of Primary Total Conventional Hip Replacement by Acetabular Mobility (All Diagnoses) .................................................................. 133
Figure HT46 CPR of Primary Total Conventional Hip Replacement by Acetabular Mobility (Primary Diagnosis OA) ..................................................... 134
Figure HT47 CPR of Primary Total Conventional Hip Replacement (Primary Diagnosis Fractured NOF) ....................................................................... 135
Figure HT48 Cumulative Incidence Revision Diagnosis of Primary Total Conventional Hip Replacement (Primary Diagnosis Fractured NOF) ............. 136
Figure HT49 CPR of Primary Total Conventional Hip Replacement by Fixation (Primary Diagnosis Fractured NOF) ..................................................... 137
Figure HT50 CPR of Primary Total Conventional Hip Replacement in Patients Aged <70 Years by Fixation (Primary Diagnosis Fractured NOF) .......... 138
Figure HT51 CPR of Primary Total Conventional Hip Replacement in Patients Aged ≥ 70 Years by Fixation (Primary Diagnosis Fractured NOF) ......... 139
Figure HT52 CPR of Primary Total Conventional Hip Replacement by Head Size (Primary Diagnosis Fractured NOF) .................................................. 140
Figure HT53 CPR of Primary Total Conventional Hip Replacement by Acetabular Type (Primary Diagnosis Fractured NOF) ........................................ 141
Figure HT54 CPR of Primary Total Conventional Hip Replacement by Acetabular Mobility (Primary Diagnosis Fractured NOF) .................................. 142
Figure HT55 CPR of Primary Hip Replacement by Class (Primary Diagnosis Fractured NOF) ......................................................................................... 144
Figure HT56 CPR of Primary Hip Replacement in Patients Aged <70 Years by Class (Primary Diagnosis Fractured NOF) .............................................. 145
Figure HT57 CPR of Primary Hip Replacement in Patients Aged ≥70 Years by Class (Primary Diagnosis Fractured NOF) .............................................. 146
Figure HT58 Cumulative Incidence Mortality of Primary Hip Replacement in Patients Aged <70 Years by Class (Primary Diagnosis Fractured NOF) .. 148
Figure HT59 Cumulative Incidence Revision of Primary Hip Replacement in Patients Aged <70 Years by Class (Primary Diagnosis Fractured NOF) ... 149
Figure HT60 Cumulative Incidence Mortality of Primary Hip Replacement in Patients Aged ≥ 70 Years by Class (Primary Diagnosis Fractured NOF) . 150
Figure HT61 Cumulative Incidence Revision of Primary Hip Replacement in Patients Aged ≥ 70 Years by Class (Primary Diagnosis Fractured NOF)... 151
Figure HT62 Primary Total Resurfacing Hip Replacement by Gender ............................................................................................................................ 152
Figure HT63 Primary Total Resurfacing Hip Replacement by Age ................................................................................................................................. 152
Figure HT64 CPR of Primary Total Resurfacing Hip Replacement by Primary Diagnosis ................................................................................................ 154
Figure HT65 CPR of Primary Total Resurfacing Hip Replacement (Primary Diagnosis OA) ............................................................................................ 157
Figure HT66 Cumulative Incidence Revision Diagnosis of Primary Total Resurfacing Hip Replacement (Primary Diagnosis OA) .................................. 158
Figure HT67 CPR of Primary Total Resurfacing Hip Replacement by Age (Primary Diagnosis OA)................................................................................. 159
Figure HT68 CPR of Primary Total Resurfacing Hip Replacement by Gender (Primary Diagnosis OA) ........................................................................... 160
Figure HT69 CPR of Primary Total Resurfacing Hip Replacement in Males by Age (Primary Diagnosis OA) .................................................................. 161
Figure HT70 CPR of Primary Total Resurfacing Hip Replacement in Females by Age (Primary Diagnosis OA) ............................................................... 161
Figure HT71 CPR of Primary Total Resurfacing Hip Replacement by Head Size (Primary Diagnosis OA) ....................................................................... 162
Figure HT72 Cumulative Incidence Revision Diagnosis of Primary Total Resurfacing Hip Replacement by Head Size (Primary Diagnosis OA) ............. 162
Figure HT73 CPR of Primary Total Resurfacing Hip Replacement by Gender and Head Size (Primary Diagnosis OA) .................................................... 163
Knee Replacement .................................................................................................................................................................................................165
Figure K1 Proportion of Knee Replacements ................................................................................................................................................................. 166
Figure K2 BMI Distribution by Gender and Knee Category ............................................................................................................................................ 168
Primary Partial Knee Replacement .........................................................................................................................................................................169
Figure KP1 CPR of Primary Partial Resurfacing Knee Replacement (Primary Diagnosis OA) .......................................................................................... 171

Figure KP2 Primary Patella/Trochlea Knee Replacement by Gender ............................................................................................................................. 172

Figure KP3 Primary Patella/Trochlea Knee Replacement by Age .................................................................................................................................. 172
Figure KP4 CPR of Primary Patella/Trochlea Knee Replacement (Primary Diagnosis OA) ............................................................................................. 175
Figure KP5 CPR of Primary Patella/Trochlea Knee Replacement by Age (Primary Diagnosis OA) .................................................................................. 176
Figure KP6 CPR of Primary Patella/Trochlea Knee Replacement by Gender (Primary Diagnosis OA) ............................................................................ 177
Figure KP7 Primary Unicompartmental Knee Replacement by Gender ......................................................................................................................... 178
Figure KP8 Primary Unicompartmental Knee Replacement by Age .............................................................................................................................. 178
Figure KP9 CPR of Primary Unicompartmental Knee Replacement (Primary Diagnosis OA) ......................................................................................... 181
Figure KP10 Cumulative Incidence Revision Diagnosis of Primary Unicompartmental Knee Replacement (Primary Diagnosis OA) ............................. 182
Figure KP11 CPR of Primary Unicompartmental Knee Replacement by Age (Primary Diagnosis OA) ............................................................................ 183
Figure KP12 CPR of Primary Unicompartmental Knee Replacement by Gender (Primary Diagnosis OA) ...................................................................... 184
Figure KP13 CPR of Primary Unicompartmental Knee Replacement by Position (Primary Diagnosis OA) ..................................................................... 185
Primary Total Knee Replacement ...........................................................................................................................................................................186
Figure KT1 Primary Total Knee Replacement by Gender ............................................................................................................................................... 187
Figure KT2 Primary Total Knee Replacement by Age..................................................................................................................................................... 187
Figure KT3 Primary Total Knee Replacement by Patella Usage ..................................................................................................................................... 188
Figure KT4 Primary Total Knee Replacement by Fixation .............................................................................................................................................. 188
Figure KT5 Primary Total Knee Replacement by Computer Navigation ......................................................................................................................... 188
Figure KT6 Primary Total Knee Replacement by Polyethylene Type ............................................................................................................................. 188
Figure KT7 CPR of Primary Total Knee Replacement by Primary Diagnosis ................................................................................................................... 191
Figure KT8 CPR of Primary Total Knee Replacement (Primary Diagnosis OA)................................................................................................................ 197
Figure KT9 Cumulative Incidence Revision Diagnosis of Primary Total Knee Replacement (Primary Diagnosis OA) ..................................................... 198
Figure KT10 CPR of Primary Total Knee Replacement by Age (Primary Diagnosis OA) .................................................................................................. 199
Figure KT11 CPR of Primary Total Knee Replacement by Gender (Primary Diagnosis OA) ............................................................................................ 200
Figure KT12 Cumulative Incidence Revision Diagnosis of Primary Total Knee Replacement by Gender (Primary Diagnosis OA) .................................. 201
Figure KT13 CPR of Primary Total Knee Replacement in Males by Age (Primary Diagnosis OA).................................................................................... 201
Figure KT14 CPR of Primary Total Knee Replacement in Females by Age (Primary Diagnosis OA) ................................................................................ 202
Figure KT15 CPR of Primary Total Knee Replacement by Bearing Mobility (Primary Diagnosis OA) .............................................................................. 204
Figure KT16 CPR of Fixed Primary Total Knee Replacement by Bearing Type (Primary Diagnosis OA) .......................................................................... 205
Figure KT17 Primary Total Knee Replacement by Stability (Primary Diagnosis OA) ...................................................................................................... 207
Figure KT18 CPR of Primary Total Knee Replacement by Stability (Primary Diagnosis OA) ........................................................................................... 207
Figure KT19 Cumulative Incidence Revision Diagnosis of Primary Total Knee Replacement by Stability (Primary Diagnosis OA) ................................. 208
Figure KT20 CPR of Primary Total Knee Replacement by Stability (Primary Diagnosis OA, Excluding Advance)............................................................ 209
Figure KT21 CPR of Primary Total Knee Replacement by Patella Usage (Primary Diagnosis OA) .................................................................................. 210
Figure KT22 CPR of Primary Total Knee Replacement by Stability and Patella Usage (Primary Diagnosis OA) .............................................................. 211
Figure KT23 CPR of Primary Total Knee Replacement by Stability and Patella Usage (Primary Diagnosis OA) .............................................................. 212
Figure KT24 CPR of Minimally Stabilised Primary Total Knee Replacement by Fixation (Primary Diagnosis OA) .......................................................... 213
Figure KT25 CPR of Posterior Stabilised Primary Total Knee Replacement by Fixation (Primary Diagnosis OA) ............................................................ 214
Figure KT26 CPR of Medial Pivot Primary Total Knee Replacement by Fixation (Primary Diagnosis OA) ...................................................................... 215
Figure KT27 CPR of Primary Total Knee Replacement by Computer Navigation and Age (Primary Diagnosis OA) ........................................................ 217
Figure KT28 CPR for Loosening of Primary Total Knee Replacement by Computer Navigation and Age (Primary Diagnosis OA) ................................. 217
Figure KT29 CPR of Primary Total Knee Replacement since 2009 by IDI Usage (Primary Diagnosis OA) ....................................................................... 218
Figure KT30 CPR of Primary Total Knee Replacement since 2009 by IDI Usage and Age (Primary Diagnosis OA) ......................................................... 219
Figure KT31 CPR of Primary Total Knee Replacement by Polyethylene Type (Primary Diagnosis OA) ........................................................................... 221
Figure KT32 Cumulative Incidence Revision Diagnosis of Primary Total Knee Replacement by Polyethylene Type (Primary Diagnosis OA) ................ 222
Figure KT33 CPR of Primary Total Knee Replacement by Polyethylene Type and Age (Primary Diagnosis OA) ............................................................. 223
Figure KT34 CPR of XLPE Primary Total Knee Replacement by Polyethylene Type (Primary Diagnosis OA) .................................................................. 226
Figure KT35 CPR of XLPE Primary Total Knee Replacement by Polyethylene Type (Primary Diagnosis OA, excluding Attune) ..................................... 227
Shoulder Replacement ...........................................................................................................................................................................................229
Figure S1 Proportion of Shoulder Replacement by Shoulder Category ......................................................................................................................... 230
Figure S2 BMI Distribution by Gender and Shoulder Category ...................................................................................................................................... 232
Primary Partial Shoulder Replacement ...................................................................................................................................................................233
Figure SP1 Primary Partial Shoulder Replacement by Class .......................................................................................................................................... 233
Figure SP2 CPR of Primary Partial Shoulder Replacement by Class (All Diagnoses) ....................................................................................................... 235
Figure SP3 CPR of Primary Partial Shoulder Replacement by Class (Primary Diagnosis OA) .......................................................................................... 236
Figure SP4 Cumulative Incidence Revision Diagnosis of Primary Hemi Resurfacing Shoulder Replacement (All Diagnoses) ........................................ 240
Figure SP5 CPR of Primary Hemi Resurfacing Shoulder Replacement by Age (Primary Diagnosis OA) .......................................................................... 241
Figure SP6 CPR of Primary Hemi Resurfacing Shoulder Replacement by Gender (Primary Diagnosis OA) .................................................................... 242
Figure SP7 Primary Hemi Stemmed Shoulder Replacement by Primary Diagnosis........................................................................................................ 245
Figure SP8 CPR of Primary Hemi Stemmed Shoulder Replacement by Primary Diagnosis ............................................................................................ 247
Figure SP9 Cumulative Incidence Revision Diagnosis of Primary Hemi Stemmed Shoulder by Primary Diagnosis ........................................................ 248
Figure SP10 CPR of Primary Hemi Stemmed Shoulder Replacement by Age (Primary Diagnosis Fracture) ................................................................... 251
Figure SP11 CPR of Primary Hemi Stemmed Shoulder Replacement by Gender (Primary Diagnosis Fracture) ............................................................. 252
Figure SP12 CPR of Primary Hemi Stemmed Shoulder Replacement by Stem Type (Primary Diagnosis Fracture) ........................................................ 253
Figure SP13 CPR of Primary Hemi Stemmed Shoulder Replacement by Stem Type and Humeral Fixation (Primary Diagnosis Fracture) ..................... 254
Figure SP14 CPR of Primary Hemi Stemmed Shoulder Replacement by Age (Primary Diagnosis OA) ........................................................................... 256
Figure SP15 CPR of Primary Hemi Stemmed Shoulder Replacement by Gender (Primary Diagnosis OA) ..................................................................... 257
Primary Total Shoulder Replacement .....................................................................................................................................................................259
Figure ST1 Proportion of Primary Total Shoulder Replacement by Class ...................................................................................................................... 259
Figure ST2 CPR of Primary Total Shoulder Replacement by Class (All Prostheses) ........................................................................................................ 262
Figure ST3 CPR of Primary Total Shoulder Replacement by Class (excluding SMR L2) .................................................................................................. 263
Figure ST4 Proportion of Primary Total Conventional Shoulder Replacement by Gender ............................................................................................ 268

a o a .o rg.a u 377
Figure ST5 Proportion of Primary Total Conventional Shoulder Replacement by Age .................................................................................................. 268
Figure ST6 Proportion of Primary Total Conventional Shoulder Replacement by Fixation ............................................................................................ 269
Figure ST7 CPR of Primary Total Conventional Shoulder Replacement by Primary Diagnosis ....................................................................................... 272
Figure ST8 Cumulative Incidence Revision Diagnosis of Primary Total Conventional Shoulder Replacement ............................................................... 273
Figure ST9 CPR of Primary Total Conventional Shoulder Replacement by Age (Primary Diagnosis OA) ........................................................................ 275
Figure ST10 CPR of Primary Total Conventional Shoulder Replacement by Gender (Primary Diagnosis OA) ................................................................ 276
Figure ST11 CPR of Primary Total Conventional Shoulder Replacement by Fixation (Primary Diagnosis OA) ............................................................... 277
Figure ST12 CPR of Primary Total Conventional Shoulder Replacement by Fixation (Primary Diagnosis OA, excluding SMR L2).................................. 278
Figure ST13 CPR of Primary Total Conventional Shoulder Replacement by Glenoid Type (Primary Diagnosis OA) ....................................................... 279
Figure ST14 CPR of Primary Total Conventional Shoulder Replacement by Glenoid Type (Primary Diagnosis OA, excluding SMR L2) ......................... 280
Figure ST15 CPR of All Polyethylene Cemented Primary Total Conventional Shoulder Replacement by Glenoid Design (Primary Diagnosis OA) ........ 281
Figure ST16 Proportion of Primary Total Conventional Shoulder Replacement by Polyethylene Type (All Diagnoses) ................................................. 281
Figure ST17 CPR of Primary Total Conventional Shoulder Replacement using All Types of Glenoid by Polyethylene Type (Primary Diagnosis OA) ..... 282
Figure ST18 CPR of Primary Total Conventional Shoulder Replacement using All Polyethylene Glenoids by Polyethylene Type (OA) ......................... 283
Figure ST19 CPR of Primary Total Conventional Shoulder Replacement by Humeral Head Size (Primary Diagnosis OA) .............................................. 284
Figure ST20 Cumulative Incidence Revision Diagnosis of Primary Total Conventional Shoulder Replacement by Humeral Head Size (OA) ................. 285
Figure ST21 Proportion of Primary Total Reverse Shoulder Replacement by Primary Diagnosis .................................................................................. 288
Figure ST22 Proportion of Primary Total Reverse Shoulder Replacement by Gender ................................................................................................... 288
Figure ST23 Proportion of Primary Total Reverse Shoulder Replacement by Age ......................................................................................................... 289
Figure ST24 Proportion of Primary Total Reverse Shoulder Replacement by Fixation .................................................................................................. 289
Figure ST25 CPR of Primary Total Reverse Shoulder Replacement by Primary Diagnosis ............................................................................................. 291
Figure ST26 Cumulative Incidence Revision Diagnosis of Primary Total Reverse Shoulder Replacement ..................................................................... 292
Figure ST27 CPR of Primary Total Reverse Shoulder Replacement by Age (Primary Diagnosis OA) .............................................................................. 294
Figure ST28 CPR of Primary Total Reverse Shoulder Replacement by Gender (Primary Diagnosis OA) ........................................................................ 295
Figure ST29 CPR of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis OA) ........................................................................ 296
Figure ST30 CPR of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis OA, excluding SMR L2) .......................................... 297
Figure ST31 CPR of Primary Total Reverse Shoulder Replacement by Glenosphere Size (Primary Diagnosis OA) ......................................................... 298
Figure ST32 Cumulative Incidence Revision Diagnosis of Primary Total Reverse Shoulder Replacement by Glenosphere Size (OA) ............................ 299
Figure ST33 CPR of Primary Total Reverse Shoulder Replacement by Age (Primary Diagnosis Rotator Cuff Arthropathy) ........................................... 302
Figure ST34 CPR of Primary Total Reverse Shoulder Replacement by Gender (Primary Diagnosis Rotator Cuff Arthropathy) ..................................... 303
Figure ST35 CPR of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis Rotator Cuff Arthropathy) ..................................... 304
Figure ST36 CPR of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis Rotator Cuff Arthropathy, excluding SMR L2) ....... 305
Figure ST37 CPR of Primary Total Reverse Shoulder Replacement by Glenosphere Size (Primary Diagnosis Rotator Cuff Arthropathy) ...................... 306
Figure ST38 Cumulative Incidence Revision Diagnosis of Primary Total Reverse Shoulder Replacement by Glenosphere Size (RCA) .......................... 307
Figure ST39 CPR of Primary Total Reverse Shoulder Replacement by Age (Primary Diagnosis Fracture) ...................................................................... 310
Figure ST40 CPR of Primary Total Reverse Shoulder Replacement by Gender (Primary Diagnosis Fracture) ................................................................ 311
Figure ST41 CPR of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis Fracture) ............................................................... 312
Figure ST42 CPR of Primary Total Reverse Shoulder Replacement by Fixation (Primary Diagnosis Fracture, excluding SMR L2).................................. 313
Figure ST43 CPR of Primary Total Reverse Shoulder Replacement by Glenosphere Size (Primary Diagnosis Fracture) ................................................ 314
Figure ST44 Cumulative Incidence Revision Diagnosis of Primary Total Reverse Shoulder Replacement by Glenosphere Size (Fracture).................... 316
Prostheses with Higher Than Anticipated Rates of Revision ....................................................................................................................................319
Figure IP1 CPR of Re-identified and still used Individual Unipolar Modular Hip Prostheses .......................................................................................... 322
Figure IP2 CPR of Re-identified and still used Individual Bipolar Hip Prostheses........................................................................................................... 324
Figure IP3 CPR of Newly Identified Individual Total Conventional Hip Prostheses ........................................................................................................ 332
Figure IP4 CPR of Re-identified and still used Individual Total Conventional Hip Prostheses ........................................................................................ 333
Figure IP5 CPR of Re-identified and still used Individual Unicompartmental Knee Prostheses ..................................................................................... 341
Figure IP6 CPR of Newly Identified Individual Total Knee Prostheses ........................................................................................................................... 346
Figure IP7 CPR of Re-identified and still used Individual Total Knee Prostheses ........................................................................................................... 347
Figure IP8 CPR of Re-Identified and Still Used Hemi Stemmed Shoulder Prostheses .................................................................................................... 349
Figure IP9 CPR of Re-identified and still used Individual Total Conventional Shoulder Prostheses ............................................................................... 351
Figure IP10 CPR of Re-identified and still used Individual Total Reverse Shoulder Prostheses ..................................................................................... 352
Figure IP11 CPR of Re-identified and still used Individual Total Ankle Prostheses ........................................................................................................ 353

AU 2017 Hip, Knee & Shoulder Arthroplasty PDF

Încărcat de

Informații document

Titlu original

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

AU 2017 Hip, Knee & Shoulder Arthroplasty PDF

Încărcat de

Drepturi de autor:

Formate disponibile

NATIONAL JOINT

Hip, Knee & Shoulder

The AOANJRR is funded by the Australian Government Department of Health

Photographer: John Gollings

2017 ANNUAL REPORT

HIP, KNEE & SHOULDER ARTHROPLASTY

President of the Australian Orthopaedic Association

D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

8 ao a. o rg. au D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6

DEPUTY DIRECTORS DIRECTOR AOANJRR STAFF

SOUTH AUSTRALIAN HEALTH AND MEDICAL RESEARCH INSTITUTE STAFF

Data Period 1 September 1999 – 31 December 2016

12 ao a. o rg. a u D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6

D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

Consultative Committee Members arthroplasty groups are included. A complete

14 ao a. o rg. a u D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6

D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

Mortality information is obtained by matching such a competing risk. In circumstances where

16 ao a. o rg. a u D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6

D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

Surgeon and Hospital Variation

This year, the Registry reports on the variation in SURGEON VARIATION

The degree of variation expected is displayed

D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

TOTAL CONVENTIONAL HIP REPLACEMENT

20 ao a. o rg. a u D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6

D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

22 ao a. o rg. a u D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6

D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

24 ao a. o rg. a u D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6

1Mth - 3Mth: HR=1.24 (1.06, 1.44),p=0.006

Number at Risk 0 Yr 1 Yr 3 Yrs 5 Yrs 6 Yrs 7 Yrs 8 Yrs

D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

10 Prosthesis Combinations with Lowest Other Prosthesis

6Mth+: HR=0.83 (0.64, 1.08),p=0.160

Number at Risk 0 Yr 1 Yr 3 Yrs 5 Yrs 6 Yrs 7 Yrs 8 Yrs

26 ao a. o rg. a u D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6

D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

PRIMARY TOTAL KNEE REPLACEMENT

28 ao a. o rg. a u D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6

D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

30 ao a. o rg. a u D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6

D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

The association between consistency and

Surgeons with less consistency were less likely

32 ao a. o rg. a u D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6

HR - adjusted for age and gender

Number at Risk 0 Yr 1 Yr 3 Yrs 5 Yrs 6 Yrs 7 Yrs 8 Yrs

D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

10 Prosthesis Combinations with

HR - adjusted for age and gender

Number at Risk 0 Yr 1 Yr 3 Yrs 5 Yrs 6 Yrs 7 Yrs 8 Yrs

34 ao a. o rg. a u D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6

D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

This difference was also evident when primary

36 ao a. o rg. a u D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6

D a t a P e r iod 1 Sep temb er 1999 – 31 Decem ber 2016

HR - adjusted for age and gender

2Wk - 1Mth: HR=0.89 (0.79, 1.00),p=0.053

14% 3Mth+: HR=1.31 (1.25, 1.37),p<0.001

Number at Risk 0 Yr 1 Yr 3 Yrs 5 Yrs 7 Yrs 10 Yrs 13 Yrs

38 ao a. o rg. a u D at a Pe r i od 1 S e p t e m b e r 1999 – 31 D e c e mb e r 2 0 1 6